Botox injections are an incredibly popular way to smooth facial lines and wrinkles — about 5.7 million cosmetic Botox procedures were performed in 2011 alone, according to the American Society of Plastic Surgeons (ASPS). But many people don’t know that Botulinum toxin — the active ingredient in Botox — is helping stroke victims, too. Even before 2002, when the cosmetic use of Botox was approved by the Food and Drug Administration (FDA), doctors used Botox to treat many conditions that weren’t just “skin deep.”
Though Botox happens to be a great way to reduce the appearance of wrinkles, the Botulinum toxin was originally used to treat neurological disorders, explains Allison Brashear, MD, member of the American Association of Neurologists (AAN) and Professor and Chair of Neurology at Wake Forest University School of Medicine in Winston Salem, N.C. One of the diseases that the Botulinum toxin is especially effective in treating is upper-limb muscle spasticity in stroke victims.
Why Botox for Stroke Victims?
A stroke occurs when blood flow to part of a person’s brain is stopped, either by a blood clot or plaque buildup in the arteries. After this happens, it is common for patients to experience muscle and nerve spasticity in their upper body, causing severe muscle toning and stiffness in the hands, elbows and arm.
Muscle spasticity following a stroke can severely inhibit a person’s day-to-day life. “At times, it causes such increased tightness that the hand collapses into itself,” says Gregory Zuercher, DO, a board-certified rehabilitation specialist at St. Joseph Hospital in Nashua, N.H. This can be very painful, and it can also make it difficult to maintain proper hygiene and perform other basic tasks, explains Dr. Zuercher. Activities like putting on clothing, using the restroom and even walking can become nearly impossible — causing stress for both the patient and the caregiver.
Botox is a safe and effective option for treating patients suffering from muscle spasticity. By injecting Botulinum toxin into the muscle, the affected muscles are weakened. “The toxin works where the nerves attach to the muscles, which is called the neuromuscular junction,” says Scott Brown, MD, Chief of the Department of Physical Medicine and Rehabilitation at Sinai Hospital of Baltimore. The nerves in this location are responsible for transmitting the brain signal that causes the muscles to contract. Botox works to block these nerves and “by blocking that transmission, the muscle can’t contract,” Dr. Brown says.
Every Stroke Patient Is Different, So Every Botox Treatment is Different
Consultation is one of the most important steps in administering Botox to a patient suffering from muscle spasticity. “Each session is very individualized as to what is the concern of the patient and what is the concern of the caregiver,” says Brashear.
Before the Botox is administered, doctors use electrical stimulation to learn which muscle or muscles require treatment. Botox is injected locally, so doctors must be very careful to administer precisely the amount needed exactly where it is needed. “Obviously, you don’t want to paralyze everything…you have to know how much to give,” says Zuercher. “There’s an art associated with it.” Brown says he might use 10 to 20 units in a small hand muscle and 50 to 75 units in a person’s biceps.
As with all Botox treatments, the effects are temporary — the Botox only lasts about three months. After that, the patient must return to the doctor for another treatment. However, Brashear explains that each treatment is specifically tailored to the patient’s present needs. “I actually have patients that get different amounts at different times,” says Brashear, adding that she has had some patients improve to the point where they no longer require treatment.
Considerations for Stroke Victims Thinking About Botox Treatment
Just as with other uses of Botox, there is a small chance that the injection could spread to other parts of the body, causing symptoms of botulism. “That’s very rare,” says Zuercher. “Certainly, it’s very well tolerated, and it’s a very safe procedure.”
“There are really very few absolute contraindications for it,” adds Brown, but he stresses that Botox isn’t a total cure. “Doctors must be very clear about the goals of the treatment,” Brown says. Because the Botox simply weakens the affected muscles and does not reverse the symptoms of muscle spasticity, it is often accompanied by physical therapy or occupational therapy in order to help patients recover as much as they are able.
A Use for Botox That More People Should Know About
Doctors have been using Botox and other forms of Botulinum toxin to treat muscle spasticity since the mid-to-late 1990s, says Brashear. Since the FDA approved the use of Botox to treat muscle spasticity in March 2010, the treatment has gained popularity.
But there is still a lack of awareness about Botox’s use to treat muscle spasticity. Many patients experiencing muscle spasticity after a stroke will still try to live with the condition, Brashear notes. “They don’t know that anything can be done,” she says. Zeurcher and Brown both reported that there are also many primary care doctors that don’t know about this treatment. “There are probably many patients that could benefit that are never referred,” says Brown.
Botox’s potential to improve the quality of life for stroke victims is nothing to ignore. Brashear says that one patient she treated was a woman whose muscle spasticity was so severe she was forced to use a wheelchair. After the Botox injections, the woman’s condition improved dramatically: “Now, she can walk by herself,” reports Brashear. “It’s really incredibly rewarding.”