Procedure

Botox is injected directly into the spastic muscle where it diffuses only a short distance. It is
dosed according to total body weight and injections can be repeated after three months. Up to
10% of patients already have antibodies to botulinum toxin and may not respond to the
injections. Children should not be on an aminoglycoside antibiotic when Botox is injected as it
may also interfere with response to the Botox.

Botulinum toxin is injected through a very small needle much like an immunization, and side
effects are few. Local tenderness can occur but is related to the volume administered.
Occasionally there may be a skin irritation or rash. Sometimes a special needle is used which
electrically localizes the muscle where the Botox is needed. This medication can be injected in a
clinic setting with the option of using a topical anesthetic for the skin and/or mild sedation.

The reported side effects of this procedure include pain at the injection site and, in some cases,
generalized fatigue of short duration. This medication is felt to be very safe at the therapeutic
doses used. 





Benefits

The muscle relaxation resulting from Botox can provide comfort and ease of care for those
patients in whom spasticity causes pain or difficulty with hygiene.

1.  The effects of botulinum toxin are seen two days to ten days after the injection and the
 results last about three to six months.

2.  If you choose Botox as the method to decrease the spasticity, please read the following:

a)  We will use a topical cream to numb the area of the injection.  This takes
 about 30-45 minutes to start working.

b)  If we are doing several injections, without anesthesia, we may need to give
 another medicine to make the procedure easier for your child to tolerate.
 Therefore, please don't eat or drink anything two hours before your
 appointment. 

c)  We will need to see you back in clinic in one week after your injection to start
 a serial cast program.

Summary :
Overall, Botox provides a non-operative way to manage spasticity in a relatively pain- and risk-
free manner. .

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