Botox Responses

Botox Responses

Marcus Boren, B.Sc., C.P.

11/26/2002

Hi Everyone,

There were kind of mixed results on my question about using botox to
work with contractures. My original thought was that by paralyzing an
opposing muscle, it might be possible to help prevent or reverse
contractures in a slow-healing patient. One response from an Australian
physician indicated that this had been successful. It would be great if
an existing contracture could be worked out by creating a muscular
imbalance, but it there weren't any reports of great success in doing
this.

Responses follow

Thanks,
Marcus Boren, B.Sc., C.P.
Clinical and Research Prosthetist
<Email Address Redacted>
www.freedom-innovations.com



We have had several patients successfully treated with botox for high
muscle tone but not necessarily
contractures.


I have had many Pts. that have had Botox, with good results for the most

part. These were all pts. that could be reduced to normal neutral
positions with forces applied. Pts. with extensor tone, cp, ect.
remember a
contracture is a shortening of the tendon. paralyzing the muscle
will not lenghten the tendon. I have seen poor results in these cases.


Botox works on muscle not tendons so if the contracture is muscle
tightness it may work.

More effective is a Baclofen pump. A physiatrist or a neurologist would
be
the best discipline to recommend and perform this treatment.


BOTOX INJECTION ARE HELP FUL IN ONLY SPASTICTYY OF MUCLES
BECAUSE OF THE ACTION ON NERVE ENDINGSWHICH GET PARALYSED
HENCE CONTRACTURE IN THE AMPUTY WILL NOT BE HELPED. AND WILL NEED
MECHANICAL CORRECTION BY POP OR OPERATION BEFORE FITTING OF THE
PROSTHESIS


Botox works to relax spastic musculature. I don't think that it would
have
an effect on shortened musculature.


We have used Botox on a patient who involuntary knee flexion post TTA.
He was in danger of developing severe contracture despite stretches,
analgesia etc and wasn't able to use a post-op cast.
Botox to hamstrings on one occaison + stretches resulted in improved
knee ROM and pt was able to undergo prosthetic rehab.


Botox will not help regular contractures. Botox works on the
neuromuscular
junction to inhibit the nerves from contracting the muscles for those
with
increased spasticity or tone, allowing for stretching, and potentially
decreasing the possibility of contractures long term. Normally,
amputees
develop contractures because of a lack of stretching, poor positioning,
long
periods of sitting, none of which have anything to do with increased
muscle
tone. Therefore, botox will not help.


Marcus, Botox works to reduce tone (spasticity) but has no effect on
muscle
myofibril length. In patients with tone such as stroke to or cp we use
botox
to cut through the tone so other treatments such as serial casting are
effective.


The way Botox is supposed to work is by blocking the neuromuscular
junction
so that the nerve cannot tell the muscle to contract. Therefore the
muscle
becomes functionally weaker. THis is useful in states such as
spasticity
where the problem is that one group of muscles is overpowering another
group. The typical contracture in an amputee is due to prolonged
non-use of
a joint where the tendon and to some extent the muscle are contracted.
THere is no particular reason to think that weakening the muscle
involved
will lead to greater range of motion.

In CP, spasticity is present.


The botox treatment for reducing spasticity in patients with upper motor

neuron involvement has been successful in a number of our patients with
Cerebral Palsy. Allowing orthotic intervention to be effective. It
usually
lasts a few months and must be repeated. A true knee or hip contracture
in
an amputee is usually a positional issue created from allowng the hip or

knee to remain in a flexed position for a long time and thus a
shortening of
the muscles. These contractures usually respond well to physical
therapy
intervention and are not ususlly created from increased tone. Since
tone
reduction is the goal of botox injections it would not usually be
indicated
in the typical hip or knee contracture seen in the amputee.


I've worked with a number of CP children who've received Botox
treatments.
My understanding is that the Botox inhibits spasticity. I've never
heard
of it's use in reducing a contracture.


Botox is useful in decrease of spasm.it acts in local area , if you have
spasm in 1 or 2 muscles its
injection can help you. but if its contracture is due capsule and muscle
or ligament shortening , you have
to consult with an orthoaped and Physioterapist.


we found in our cp child the contractures return with a vengance after
the three to four months. we thought at first it was our
fault but now we have numerous patients with the same result. I would be
extremely conservative in this approach


Botox cannot lengthen muscle tissue


I think you'll find that Botox is controlling the tone by blocking
calcium
uptake (or some such thing) in the action potential of nerve cells.
Reduction of the tonic deformity would therefore be achieved, if a true
contracture were not present.


In the case of an amputee with a true contracture, the muscle fiber has
actually changed and is no longer elastic. The two are simply not
related.
I might recommend a book titled Basic Human Neurophysiology, by David F.

Lindsley and J. Eric Holmes, which does a fairly nice job of explaining
the
difference between tone (rigidity) and true connective tissue
contracture.


la Toxina Botulínica es un bloqueador de la placa neuromuscular y por
esta razón regula el ton muscular, característica neurologica
especial.
la contractura articular es un fenómeno del tejido fibrosos de la
cápsula, el cual se adhosa y pierde elasticidad.
caso parecido sucede con la retracción muscular, siendo perdida de la
elasticidad tisular del músculo. por lo cual el uso de la toxina es
muy poco viable en estos casos,dado su alto costo y muy poco
beneficio. preferiéndose el uso de dispositivos ortésicos de
extensión, cuando esto sea posible. De lo contrario es mejor adaptar
los dispositivos ortesicos o protésicos a la contractura.