Cerebral Palsy and Botox Treatment

Fact Checked

Botox treatment is a temporary injectable therapy to reduce muscle spasticity.[1] Botox injections can help children with cerebral palsy get relief from spastic muscles and pain. Botox is not FDA-approved for cerebral palsy, but some doctors use it in an off-label capacity.

What Is Botox?

Botox is the brand name for an injectable drug made from a highly toxic substance created by bacteria, botulinum toxin A. The bacterium Clostridium botulinum produces this potent neurotoxin. When ingested, it is highly toxic and deadly.

• Food that has spoiled and been contaminated by this bacterium causes the illness known as botulism. It is a very serious and sometimes fatal type of food poisoning.

• In smaller doses and injected locally rather than ingested, botulinum toxin A can be used for cosmetic and medical reasons. Allergan developed Botox and got approval from the U.S. Food and Drug Administration (FDA) in 1989.

• The FDA has approved it for several uses, including overactive bladder and urinary incontinence, migraines, and several conditions and symptoms involving the muscles. It is also used cosmetically to smooth wrinkles and reduce sweating.

• Botox works for these medical treatments by weakening or completely paralyzing specific muscles into which it is injected or blocking particular nerves from firing. The paralysis or weakening effect is not permanent and eventually wears off.

• This action has the effect of relaxing muscles and decreasing pain, as well as other related effects. Used as a local injection, Botox is not likely to cause botulism, but there are some risks and potential side effects.

Botox for Cerebral Palsy Spasticity

Among the approved uses for Botox are several that relate to muscle function. It is approved to treat muscle spasticity and dystonia of the neck in adults, which is repetitive and abnormal muscle movement that can be painful or debilitating.

It is important to note that the FDA has not approved Botox to be used in children with lower limb spasticity, but this is exactly how it is used in some children with cerebral palsy.

A medication not approved for a specific use does not mean that it is banned for that use. Healthcare providers can use professional discretion to determine if the benefits outweigh the risks of some of these medical interventions.

Some children benefit from Botox, specifically for spasticity in the lower body.[2] Other uses may include injecting Botox into specific muscles, anywhere in the body, that are experiencing spasms.

Some of the benefits these children may see from injections include:

• Better range of motion
• Better positions of limbs and joints
• Fewer spastic movements
• Less pain
• Improved gait

The relief it provides also means that surgery to correct muscle and joint problems may be delayed until the child is older and there are fewer risks.

More recent studies have confirmed that Botox can benefit children with cerebral palsy. This includes studies of neuromuscular electrical stimulation therapy used after the injection. Researchers have found that this combination amplifies the beneficial effects.[3]

How Is Botox Administered?

Botox is administered by injecting the medication directly into the location where it is needed. Doctors can administer it in their offices on an outpatient basis.[4]

To minimize a child’s discomfort with getting a shot, the area to be injected can be first sprayed with a numbing substance.

The area will also be disinfected first to avoid infection. The treatment may include one or more injections, depending on the size of the muscle group and the severity of symptoms.

Are There Side Effects of Botox Injections?

Localized Botox injections do help some children feel better and move better, but Botox injections are not without risk.

Approval for Spasticity Treatment

The packaging information for the medication states explicitly that it is not known whether these injections are useful or safe for treating lower limb muscle stiffness.

This statement is required since there have been no clinical trials for this particular use of the medication, and the FDA has not approved it for spasticity in children.

Black Box Warning

The FDA also required Botox packaging to include a special black box warning. This type of warning is reserved for the most serious and potentially life-threatening side effects of a drug. For Botox, that warning states that the toxin may spread beyond the injection site and cause symptoms of botulism.

In cases where this has been reported, the symptoms occurred anywhere between a couple of hours to a couple of weeks after the injection. This effect can lead to death, and the risk is most significant in children being treated for spasticity.

The warning should be taken seriously, but the overall risk of this occurring is low.

Other Side Effects

There are some more common and less serious side effects, though. These include general weakness, weakness in the limb injected with Botox, pain at the injection site, and infection at the injection site.

The Long-Term Potential of Botox as a Cerebral Palsy Treatment

An injection of Botox is not currently considered a permanent solution for muscle spasticity in children with cerebral palsy. The effects of a Botox injection are temporary, no matter the use. How long it lasts depends on the individual, the amount injected, and the purpose of the injection.

Studies have, however, looked into whether or not these injections could improve a child’s muscle tone and movement over time.

In one study, the researchers concluded that multiple injections over two years had positive long-term effects. Muscle tone and gross motor function were measured in these children before injections and nearly two years after repeated injections.

The muscle tone did not seem to change over time, but the researchers saw improvements in gross motor function. In other words, the children still had high tonicity but had improved movement.[5]

Botox injections have the potential to help a child struggling with spastic muscle movements because of cerebral palsy. There are risks and the potential for side effects, not to mention the potential for a life-threatening infection.

Parents and doctors must decide if the risks are worth the child’s benefits in terms of movement, comfort, and pain relief.