Botulinum Toxin A [BTA]|
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What is Botulinum Toxin A?
Botulinum Toxin A [BTA] is a muscle relaxant derived from the
bacterium Clostridium Botulinum. This bacteria has associations with botulism, a
rare form of food poisoning, but can, like many toxic substances when used in
small, controlled doses, provide safe, effective relief from a number of
conditions. Currently BTA, under the brand name Botox™, is perhaps more commonly
associated with face-lifts.
Botulinum Toxin A is not
BTA is not a cure for cerebral palsy, nor is it a suitable
treatment for all forms of cerebral palsy.
Origins of the treatment
This is not a new treatment. BTA has been used therapeutically
for over 20 years, mainly with adults, to treat a variety of conditions
characterised by muscle hyperactivity.
BTA is licensed in the UK to treat pes equinus in children
with cerebral palsy. Pes equinus, often referred to as tip-toe walking,
is very common in children with cerebral palsy, and results from spasticity in
surrounding muscles which makes it difficult, or impossible, to place the foot
flat on the floor. When injected into the calf muscle[s] [gastrocnemius
and/or tibialis], BTA can relax these muscles, making walking easier and
more comfortable, as well as generally improving balance and reducing the
frequency of falls.
Tightness in the muscles at the back of the thigh [hamstrings],
makes it difficult to straighten the leg/s, resulting in crouch or
squat gait. Injection with BTA can help straighten the legs, resulting in
improvements in walking, sitting and/or transferring. BTA is also used to good
effect on the adductor muscles in the hip, again a common problem area
for children with spastic cerebral palsy. Too much muscle tone in this area
impacts on the individual's mobility by making it difficult to keep the legs
apart [also known as scissoring]. For those with upper limb spasticity,
BTA can reduce muscle tone around the elbow, wrist and thumb areas and improve
pinching, grasping and releasing movements.
In addition to these functional gains, BTA also has the potential
to minimise the development of secondary problems. Spasticity can create an
imbalance in muscle tone across a joint that not only interferes with motor
function but can also lead to fixed contractures [permanent shortening of the
muscle and tendon], bony abnormalities and joint instability, such as hip
Often surgery will be required, and the earlier this is carried
out, the more likely it will need to be repeated as the child grows and matures.
Lowering the tone of the more active muscle[s] by using BTA can restore balance
across the joint, increase the stretch of the muscle and promote longitudinal
growth, thereby possibly avoiding, or at least minimising, both potential damage
to that joint and the need for surgical intervention.
As the use of BTA has become more widespread in the treatment of
cerebral palsy in both children and adults, goals have expanded to include pain
relief, improved positioning, tremor and spasm control, drooling management and
facilitation of personal care. Treatment prior to adductor release surgery can
significantly reduce post-operative pain, pain management requirements and the
length of stay in hospital. Many surgeons use BTA during operations to reduce
painful post-operative spasms and to protect soft tissue from involuntary
movement until the healing process is complete.
Many teenagers and adults with cerebral palsy report a high level
of satisfaction with the cosmetic improvement that BTA can bring about to their
appearance, even where there has been no significant change in function or
Tiredness can often be a problem for people with cerebral palsy,
due to the increased effort required in moving around. As movement becomes more
fluid following BTA treatment, there is often a consequent reduction in energy