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Botox Injections Help Children with Cerebral Palsy|
(DukeMedNews) Doctors at Duke Children's Hospital are treating the tight muscles
caused by cerebral palsy with Botox injections. When given in combination with
physical therapy, the shots help patients strengthen their weak muscles and
restore normal movement.
The medication is injected into the muscles during an outpatient visit. Although
anesthesia is not required for Botox injections, Duke pediatric neurologist
Pedro Weisleder, M.D., Ph.D., teamed with Duke pediatric anesthesiologist
Allison Ross, M.D., to develop a system for sedating children with inhaled
anesthetics similar to the laughing gas used in many dental offices.
"Children don't take well to needles or painful procedures, and several parents
asked if we could perform the injections under anesthesia to eliminate their
child's pain," said Weisleder, an assistant professor of pediatric neurology at
Duke University Medical Center. "The end result is that the procedure is
painless and post-anesthesia recovery is rapid. It also allows me to give more
accurate injections," he said. To identify the correct muscles for injection,
Weisleder uses a special needle through which he can both electrically stimulate
the muscles and deliver the medication.
The effects generally last about three months. During that time, patients work
with a physical therapist to stretch and strengthen their weaker muscles. "Our
goal is not to paralyze the muscles, it is to rebalance them around the joints,"
In cerebral palsy, the brain loses the ability to moderate the activity of
contracting muscles. Muscles that produce contraction are stronger than those
that produce extension, Weisleder said. Partially paralyzing the stronger
muscles with botulinum toxin gives patients an opportunity to stretch and
strengthen the weak muscles, he said. The long-term goal of the two components
of the treatment – injections and physical therapy – is to achieve better muscle
strength balance which may lead to restoring normal function, Weisleder said.
Cerebral palsy encompasses a group of physical and movement disorders that
appear in the first few years of life. The muscle spasticity and tightness
caused by the disorder make it difficult for people to perform fine motor tasks,
such as writing, and causes problems with balance and walking. Though the
disorder itself is not progressive, the consequences of the muscle spasms worsen
over time, Weisleder said. Spasticity can interfere with daily activities and,
in more severe cases, cause significant pain and snap joints out of alignment.
Weisleder cautions that not every patient with cerebral palsy will benefit from
Botox injections, and the amount of toxin a child can receive at each visit is
limited by their body size.