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Botulinum is a nerve toxin made by the food poisoning bacteria Clostridium Botulinum. It causes a time-bound paralysis in affected muscles. Diluted purified Botulinum toxin is injected into muscles in persistent spasm, to cause a calculated degree of flaccid paralysis, so that the remaining viable muscles can obey voluntary muscular commands in a better coordinated way. However this mode of therapy has certain limitations
The rapidity of relief from spasticity in Spastic CP with Botulinum Muscle Infiltration Injection or Phenol Nerve Block is magical.
It destroys the “plug point” on the nerve fiber just at the point (neuro-muscular junction) where it encounters the muscle cell to be stimulated. This prevents release of stimulation causing chemicals called Acetyl Choline, that are necessary to inform the muscle fiber to contract. Though the main effects of the toxin are at the peripheral muscle level, some blocking actions are also seen at a more central level.
When the drug is medically injected into a specific muscle belly by an experienced doctor, it causes weakness to paralysis of the muscle depending on dose used. The effect starts within 2-3 days and peaks within 10 days. However, since the originating nerve cell of the treated nerve fiber is safely hidden undisturbed within the spinal cord, hence the nerve endings regenerate the junction point within 4 to 6 months in most cases.
However, the effects are temporary, up to 4 to 8 months in most cases of CP. Botulinum toxin, a muscle-nerve paralyzing bacterial toxin, is being used for controlled partial muscle paralysis in regulated doses to relax spastic muscles to improve function in Cerebral Palsy. However, the development of anti-toxin antibodies by the body, and regeneration of destroyed nerves within 2 to 4 months in most cases, limits its usefulness. Moreover, its sudden freedom from spasticity takes away the motivation for continued intensive OT/PT, and often results in the child going back to square one after a few months.
The NIH, USA cautions that though Botulinum toxin has shown great promise in relieving persistent spasticity due to stroke or cerebral palsy, its long term safety and efficacy are still under investigation, more so in children, where its long term effects are still to be established.
We at UDAAN rarely now go in for Botox or Phenol Nerve Block.