Can Botox Injections Offer Relief From Spasticity?

Botulinum toxin — better known by the brand name Botox® — is best known for its ability to erase the wrinkles of time. But its muscle relaxant effect can also be a powerful tool for those living with spasticity.

Targeted injections of the medication can help calm stiff and spasming muscles that make moving through daily life more difficult. It’s often most effective in treating spasticity that affects only a few muscles or specific muscle groups.

“Botulinum toxin has been shown to be a low-risk, high-reward treatment option for people living with spasticity,” says rehabilitation specialist Francois Bethoux, MD. “It effectively relaxes spastic muscles by temporarily changing the communication between nerves and muscles.”

So, could Botox therapy be a solution to relieve your spasticity? Let’s take a closer look with Dr. Bethoux.

How does Botox work for spasticity?

“Spasticity” is the term for muscles that are stiff or move involuntarily because of nervous system damage. Someone experiencing spasticity may clench their fists, point their toes or cock their head to one side without being in control of those movements.

But those muscles aren’t just acting out on their own. They’re following instructions from the brain delivered through nerves, which release a substance called acetylcholine to relay the commands.

If you have spasticity, nervous system damage results in a flood of wrong orders being delivered. Basically, your nerves tell your muscles to spasm and tense up when they should be allowed to relax.

Botox addresses that messaging mayhem by blocking the release of acetylcholine from the nerve to the muscle. Shutting down this miscommunication allows your muscles to loosen up (both literally and figuratively).

“For those living with spasticity, relaxing the muscles means less stiffness in the muscles and improved range of motion,” explains Dr. Bethoux.

Three formulations of botulinum toxin A are approved by the U.S. Food and Drug Administration (FDA) for treating spasticity. They are:

• AbobotulinumtoxinA (Dysport®)
• IncobotulinumtoxinA (Xeomin®)
• OnabotulinumtoxinA (Botox)

Conditions with spasticity where Botox may help

Botox may be effective in treating spasticity that is common in conditions that affect the brain or spinal cord, including:

• Multiple sclerosis (MS)
• Stroke
• Cerebral palsy
• Spinal cord injury
• Brain injury

Where is Botox injected for spasticity treatment?

Botox is given as an intramuscular injection, best described as a shot that goes into your muscle. The injections are given during an outpatient visit that will probably take 30 minutes to 45 minutes.

To ensure the medication is injected in the right place, electrical signals are recorded from your muscle or sent through the needle into your muscle during the injection. Ultrasound is sometimes used to directly visualize your muscle and the needle.

Because the botulinum toxin doesn’t travel far from the injection site, your doctor will likely perform several injections during your visit.

Injection treatments are generally repeated every three months.

What can you expect after an injection?

After an injection, you may not notice any difference for a few days or even up to two weeks.

“That’s perfectly normal,” notes Dr. Bethoux. “Once the effects take hold, you should see improvements that last for about two to three months.”

In many cases, physical or occupational therapy may be recommended after the injections to maximize the benefits of the treatment. You’ll also be advised to stretch and exercise daily at home.

Possible side effects of Botox for spasticity

While botulinum toxin therapy is generally considered a safe option for people living with spasticity, there may be some side effects.

“Patients may experience some pain and bleeding at the time of injection and soreness or bruising for a few days following the injections,” cautions Dr. Bethoux. “In some instances, you may feel tired or have flu-like symptoms for a day or two after treatment.”

Rare but potentially concerning side effects also include spreading the effects beyond the muscles injected. This could lead to temporary widespread weakness or even difficulty swallowing or breathing.

Botox can also have a weakening effect on muscles, which is why the targeted muscles and doses injected should be carefully chosen. Long-term therapy may lead to muscle atrophy. Stopping the treatments will generally reverse this effect.

Are you a good candidate for Botox therapy?

Your healthcare provider may recommend Botox if your spasticity is limited to only a few muscle groups — your arms or legs, for example. Botulinum toxin may also be helpful when many muscles are spastic but only a few spastic muscles are causing issues.

As with any treatment method, there are pros and cons to using Botox as part of your plan for spasticity relief.

Advantages

• Botox is typically effective in relaxing the injected muscles for several months.
• Botox is usually very well tolerated, in part because only very small amounts of medication go into your bloodstream.

Disadvantages

• Botox needs to be injected, which is less convenient than taking a pill.
• There are limits to the amount of Botox that can be injected during one session and to the frequency at which Botox can be injected.
• It’s possible that your body could create antibodies against Botox. These antibodies aren’t dangerous but they may make treatment less effective.

Is Botox therapy worth considering for spasticity?

Spasticity doesn’t always need to be treated, but it’s best to consider action if it’s causing pain and discomfort or disrupting day-to-day life. Talk with your healthcare provider about whether a Botox spasticity treatment may be an option.

Although the therapy doesn’t work for everyone, many find relief.

“We’ve found botulinum toxin therapy to be a useful approach in the treatment of spasticity,” states Dr. Bethoux. “When combined with rehabilitation and exercise, botulinum toxin has the potential to improve quality of life.”