Spasticity is a muscle condition characterized by stiff or tight muscles and involuntary muscle movement. It occurs as a side effect of conditions of the nervous system, such as cerebral palsy, traumatic brain injury, stroke, multiple sclerosis and spinal cord injury.
Symptoms of spasticity include increased muscle tone, overactive reflexes, involuntary movements, pain, decreased functional abilities and delayed motor development.
There are several oral medications used to treat spasticity. However, injections of botulinum toxin (Botox) near the affected muscles have also been shown to be quite effective.
Why use Botox for spasticity?
Botox helps relax the muscles by blocking messages from the brain that tell muscles to contract (tighten). Botox injections can help increase mobility, relieve pain, maximize comfort, facilitate muscle growth and ease caregiving.
Botox injections are done by interventional radiologists using image guidance.
Risks of Botox
Botox is usually considered safe. However, there is a small possibility that unexpected or unusual reactions to Botox will occur. These reactions may even take place in areas of the body that were not injected. Unusual reactions have been known to occur within the first few weeks following treatment. These reactions include:
- fever
- muscle soreness that lasts longer than two days
- pain, bruising, redness or swelling at the injection sites
- loss of bladder control
- malaise (generally feeling unwell)
Call your child’s health-care provider or go to the nearest Emergency Department if your child is experiencing any of the following symptoms:
- severe weakness
- speech that is becoming more difficult to understand, or voice changes (e.g., hoarse voice)
- difficulty breathing
- drooping eyelids or changes in vision
- allergic reaction (anaphylaxis)
Because Botox has a delayed response, these symptoms usually indicate that Botox has been injected somewhere beyond the targeted muscle.
Visiting the clinic before the procedure
Your child may have to visit the interventional radiologist one to three weeks before receiving the Botox injections. During the visit, you should expect the following:
- A health assessment to make sure your child is healthy and that it is safe to have general anesthesia.
- An overview of the procedure and a review of the consent form.
Giving consent before the procedure
Before the procedure, the interventional radiologist will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks and will help you weigh any benefits against the risks. It is important that you understand all these potential risks and benefits of the Botox injections and that all your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.
How to prepare your child for the procedure
Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
If your child becomes ill within two days before the procedure
It is important that your child is healthy on the day of their procedure. If your child starts to feel unwell or has a fever within two days before the Botox injections, let their health-care provider know. Your child’s procedure may need to be rescheduled.
Food, drink and medicines before the procedure
- Your child’s stomach must be empty before receiving the general anesthetic.
- If your child has special needs during fasting, talk to their health-care provider to make a plan.
- Your child can take their regular morning medicine with a sip of water two hours before the procedure.
- Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure. If your child is taking any of these medicines, please discuss this with their health-care provider and the interventional radiologist.
On the day of the Botox injections
Arrive at the hospital two hours before the planned time of your child’s procedure. Once you are checked in, your child will be dressed in a hospital gown, weighed, and assessed by a nurse. You will also be able to speak to the interventional radiologist who will be doing the Botox muscle injections, and the anaesthetist who will be giving your child medication to make them more comfortable during the procedure.
During the procedure, you will be asked to wait in the surgical waiting area.
Your child will have medicine for pain
Children are given medicine for treatments that may be frightening, uncomfortable or painful. For Botox muscle injections, most children are given general anaesthesia.
How are Botox injections done?
The interventional radiologist uses an ultrasound and muscle stimulator to locate the targeted muscles for injection. Once the muscle is located, a tiny needle is used to inject a small amount of Botox into the muscle. This procedure is repeated for each of the desired muscles.
Botox muscle injections can take from 60 to 90 minutes, depending on the number of muscles being injected.
After the Botox injections
Once the injections are complete, your child will be moved to the recovery area. The interventional radiologist will come and talk to you about the details of the procedure. As soon as your child starts to wake up, a nurse will come and get you.
Going home
Most children will go home within one hour of receiving the Botox injections. If your child has any medical conditions such as sleep apnea, you may be asked to spend the night in hospital for observation purposes.
For more details on how to care for your child after muscle Botox injections, please see Botox therapy for spasticity: Caring for your child at home after the procedure.
What to expect after Botox injections
Botox injections start to work a few days after the treatment. It is most effective one to two weeks after injections, and results gradually wear off after three to six months.
Your child may experience muscle soreness or bruising at the injection sites. However, they should not experience any severe pain. Acetaminophen can be given for pain management if needed. After the injections, your child can return to their regular activities. If your child wears leg braces, they can begin wearing them again.
At SickKids
At SickKids, the interventional radiologists work in the Department of Image-Guided Therapy (IGT). If you have any concerns in the first 48 hours, you can call the Image Guided Therapy (IGT) clinic at (416) 813- 7654 ext. 201804. Speak to the IGT clinic nurse during working hours or leave a non-urgent message.
For more information on fasting see Eating and drinking before surgery.
For more information on preparing your child for their procedure see Coming for surgery.
A nurse from IGT will phone you at home the day after the procedure to make sure your child is okay, and to answer any questions you may have.