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Botox Injections to Reduce Spasticity

After a stroke, miscommunication between a patient's brain and muscles could cause the muscles to contract involuntarily, becoming stiff, a condition known as spasticity. Botox is one proven method for treating spasticity and relaxing muscles in stroke patients.

Botulinum toxin type A (BoNTA) treatments given repeatedly over the course of a year following a stroke have been shown to increase muscle tone and lessen pain in the hands and arms, making it simpler for patients to dress and take care of their personal hygiene. The treatment results in long-term and significant functional improvement, making a difference in the lives of stroke patients and those who care for them.

Botox® injections were approved by Health Canada in November 2001 to treat spasticity, which occurs after a stroke when muscles can no longer respond to signals from the brain telling them to relax and instead remain contracted. A bent elbow, clenched fist, arm pressed against the chest or flexed wrist are all symptoms of post-stroke spasticity.

Spasticity Due to Stroke 

Spasticity is a condition whereby muscles stiffen because of spasms or prolonged contraction following neurological injuries such as stroke. Many patients often assume that spasticity is caused by a problem with their muscles, but the problem is actually caused by a breakdown in communication between their brain and their muscles.

When the motor cortex is damaged by a stroke, the brain's capacity to instruct the muscles to contract or relax is impaired. Because of this lapse, multiple muscles may contract involuntarily without relaxing, resulting in spasticity. 

Spasticity can be painful over time and could lead to other complications like contracture. When muscles are unable to fully relax or elongate, contracture occurs, causing the muscles to become tighter and even shorter over time. This could impair the range of motion or limit performance in a variety of daily activities.

How Botox Reduces Spasticity 

Botox is a substance derived from Clostridium Botulinum. When Botox is stripped of its bacterial components, it produces a neurotoxin that can be injected into the affected areas in small doses. Through this injection, the Botox complex relieves the contractions and blocks nerve signals, effectively paralyzing the muscles. Botox injections enable the nervous system to regrow muscle nerves in people who have spasticity. Botox, as a spasticity therapy, helps to reduce muscle tightening and, thus, enhances normal nerve communication in stroke patients.

One study revealed that spasticity reduction significantly improved arm function following a stroke. It implies that a moderate dose of Botox reduces spasticity for long enough to allow functional improvements without resulting in a significant decrease in strength.

For patients with spasticity, Botox can:

  • Provide significant pain relief
  • Last in between 12 and 16 weeks 
  • Reduce muscle spasms and signs of tightening 
  • Allow the nervous system to grow new, healthier muscles 

Botox® relaxes the damaged muscles, minimizing spasticity and allowing patients to operate more normally, including better hygiene, the ability to dress, and pain management. In a large study of 126 patients, the effectiveness and safety of injections in the treatment of wrist and finger spasticity resulting from stroke were investigated.

Botox® outperformed placebo (non-drug injections) in terms of improving the wrist and finger muscle tone and reducing disability in patients' lives for at least three months after a single treatment. Pain at the injection site, dizziness, headache, and muscle weakness was among the minor side effects (Brashear 2002).

However, it is crucial to understand that Botox is not a permanent solution. Botox just provides temporary relief since it does not treat the underlying origin of spasticity (miscommunication between your brain and muscles). The effects of the injection typically last 3-4 months – spasticity will recur unless you get another injection.

Patients can achieve long-term improvement in spasticity and muscle function by taking advantage of the reduced muscle tone caused by Botox and addressing the root cause of spasticity.

Maximizing the Benefits of Botox for Stroke Patients 

When Botox is not used alongside physical therapy to restore brain-muscle communication, it becomes only a temporary treatment. It's similar to taking pain relievers for a broken ankle and not wearing a cast. The painkillers will alleviate the discomfort, but you are not addressing the underlying issue.

That is why it is critical to treat spasticity on two levels: temporarily relieve symptoms with Botox and improve the root cause in the long term with rehab exercises. This allows you to gain strength and enhance mobility while Botox is at its most effective.

An Effective and Painless Treatment 

Research indicates that up to 30% of stroke patients have disabling muscle tightness, also known as muscle spasticity. When muscle spasticity affects the arms and hands, stroke patients find it difficult to dress, feed themselves, bathe as well as perform other normal tasks. The good news is that Botox provides an effective and painless treatment for spasticity associated with stroke. 

Approved Indications for Botox