Managing Spasticity in Children with Botulinum Toxin Injections

Disclaimer: This information sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

Botulinum Toxin A: Injections

Botulinum toxin A is a treatment in which spasticity can be managed with a series of injections. It is usually effective at treating children and adolescents with spasticity, but not fixed contractures.

Botulinum toxin A is produced by Clostridium botulinum, a bacterium found in nature. Nerves in the body, which would normally send messages to muscles to contract, absorb the toxin after it is injected near the nerve-muscle junctions. Botulinum toxin A blocks the release of the chemical messenger responsible for muscle contraction. The toxin produces a temporary paralysis of the muscle at the injection site and this reduces spasticity, and allows for improved function of the muscle in most instances. The effect of the Botulinum toxin A is reversed naturally by the body over 3 to 6 months. The nerve then becomes active again and so this also means that spasticity returns, and may require further treatment.

Children are carefully assessed by a Paediatric Rehabilitation Specialist before a decision is made to use Botulinum toxin A. If a decision is made to proceed with the treatment, the child is also re-assessed 3 to 4 weeks after the injections to see how well it has worked. This assists in making the decision about whether to give a further course of injections in the future. The Botulinum toxin A is given into the muscle by injection at 1 to 4 sites per muscle. As there are several injections, a local anaesthetic cream (EMLA®) and sedation with nitrous oxide inhalation (laughing gas) is used for the procedure. After the procedure, which takes approximately 20 minutes, the nitrous oxide is "reversed" by the child breathing oxygen, and they are able to eat and resume normal activities straight after the injections. As the nitrous oxide can make some children nauseated, children should be fasted for 2 hours before their appointment time in the Clinic.

Possible side-effects from this treatment include excess weakness, bruising or bleeding at the injection site, temporary changes in bowel and bladder function, or nausea from the nitrous oxide. Your specialist will discuss these with you prior to proceeding with the treatment to ensure you are fully informed.

You should be aware that although this treatment may be effective for many children, it is not effective for all children. You can discuss the alternatives with your specialist, and your child will receive the best level of care, regardless of your decision to proceed with this treatment or not. If you would like more information on Botulinum toxin A, please contact any of the following specialists:

• Dr Stephen O'Flaherty (02) 9845-2819
• Dr Mary-Clare Waugh (02) 9845-2131
• Dr Adam Scheinberg (02) 9845-2769

Appointments to attend the Botulinum Toxin Clinic held in the Child Assessment Centre, Level 3, on a Monday and Tuesday can be made on (02) 98452819. Referrals to the Clinic can be made by your yourself, family doctor, paediatrician, other medical specialists or members of your child's therapy team.

For more information about treatment of Spasticity please refer to links below:

• Intrathecal Baclofen
• Oral Baclofen

Rehabilitation Department The Children's Hospital at Westmead Cnr Hawkesbury Rd & Hainsworth St, Westmead Locked Bag 4001, Westmead, 2145 Tel: (02) 9845 2132 - Fax: (02) 9845 0685 http://www.chw.edu.au/rehabilitation/