Botox and Stroke

By Kathy Saul



Muscle tightness, or spasticity affects up to 30% of stroke survivors. This condition, if not dealt with effectively, can result in disabling contractures, which can leave muscles and tendons permanently shortened. Stiff hands and wrists are painful and can make daily tasks such as washing and dressing difficult and even impossible.


Prior to my stroke, I thought that Botox was used for cosmetic purposes to reduce lines and wrinkles. Now, I’m at the age when Botox could be a cosmetic consideration. So, I confess, I get my Botox treatments on a regular basis these days. My wrinkles and facial lines have not diminished but the muscle tone in my left hand; wrist, arm and scapula have improved dramatically.


Botox or botulinum toxin type A, is a protein complex produced by the bacterium Clostridium botulinum and is the same toxin that causes food poisoning. The drug Botox is a sterile, purified botulin toxin that, when used in small doses block the release of acetylcholine, a chemical released by our nerve cells that tell our muscles to contract.


Dr. Allison Brashear, a professor and chairman of neurology at Wake Forest University Baptist Medical Center in Winston-Salem NC states, “It’s evident that Botox makes a difference in function and pain.” She is referring to post stroke survivors with spasticity. The American Stroke Association estimates roughly one-third of the 750,000 people in the United States who suffer a stroke experience spasticity issues and pain.


Dr. Brashear’s study team involved 279 stroke patients with muscle spasticity. During her year long study Botox treatment injections were given at twelve week intervals in patient’s wrists, fingers and elbow flexors. Hygiene, dressing, limb posture and pain were the four areas of muscle tone and disability used to measure patient improvement.


Botox side effects may include headache, pain in the arm or flu like sickness. Fewer than 20 people in the study reported side effects and 50% of the study group reported improvement in one of the four areas of muscle tone and disability.


According to Dr. Brashear’s study, "Botox treatment can result in sustained and meaningful functional improvement that makes a difference in the daily lives of stroke patients and the people who care for them.”


Stroke Network Members Report


An informal survey of Stroke Network members resulted in a variety of responses on the effectiveness of Botox. Here are a few members’ responses:


Maria states she is the “queen” of Botox and could not live without it. Her Botox treatments are so effective on the spacticity in her affected arm and hand that she cannot imagine living without the stuff.


Denise wrote she has been receiving Botox for the past year due to excessive tone in her quads, hand and big toe. For Denise the Botox has made it easier to get in and out of the car, uncurl her fingers and put on her shoes.


Rachel said she has had two Botox treatments and while they seemed to help the problems with her knee and foot, the effects are quite short lived. She and her doctor are looking into increasing the dose.


Gary wrote that he had Botox injections three or four times, but they did not provide permanent relief so he quit the treatment. Gary also said the injections were fairly painful.


Amy states that she has had great success with Botox and the difference in her arm and hand are wonderful.


Finally, Brian a physical therapist notes the importance of the physician using an EMG (a needle that is injected into the muscle that is connected to a machine that makes noise letting the clinician know he or she is injecting the right spot. Brian goes on to say not only must the Doctor inject the right spot; he has to use enough Botox for the patient to have a favorable result.


For more information on Botox see the FDA site.



Editor’s Note:


Now that you have read Kathy’s article and the comments from Stroke Network members do you still have questions? Here is a link to a list of URLs where you can research further.



Copyright © April 2009

The Stroke Network, Inc.

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