Who? Why? When and where?
Botulinum toxin is a toxin produced by bacteria that causes muscle paralysis, and that is exactly what it is used for. Humans have managed to isolate the toxin and use it to their advantage for cases where we want to reduce the nerve signals to muscles, salivary or sweat glands.
We can start with, who! Who needs it? People struggle with muscle tightness after suffering strokes, brain injuries, or spinal cord injuries. They also might have a hard time with their ability to swallow, causing issues with excessive drooling after brain damage. All of this applies to children with cerebral palsy or brain injury, as well.
- Why! The toxin is used because it reduces the nerve signals. So, tight muscles relax, and glands that produce saliva or sweat produce less.
- When? We use this approach when any of the above conditions are affecting quality of life, affecting movement, causing pain, contractures, difficulty with care or when other treatments, such as PT and splinting, are not enough. This is especially important in growing children as you have to keep up with their bone growth.
It is typical for the children to require a set of injections twice a year until they are done with their growth. After that, they may need it, but less frequently.
- Where? The toxin works where it’s injected. So, targeting the proper muscles is very important. These are identified based on physical exam, gait assessment, and discussion with the patient and/or their parents. I prefer that the Injections should be done under guidance, whether it’s ultrasound or electrical guidance, to help make sure that the medicine was delivered to the right muscle (because, as we said before, the toxin works where you place it).
Same is true for salivary glands but the selection process is much simpler. Toxin is injected into the largest salivary gland on both sides which are called the parotids. This helps minimize the amount of saliva but not completely stop it (as there are 2 other glands that are still working on each side).
