Botulinum toxin is produced naturally by the bacterium Clostridium botulinum. It is used to increase mobility and maximize comfort in patients suffering from muscle conditions such as spasticity. When injected into muscles, botulinum toxin has a local affect. It blocks the messages between the nerve endings and muscle fibres around the injection site, causing weakness of the nearby muscle. Injections usually take effect within a few days, with peak relaxation four to six weeks later, although this can vary from child to child.

These chemical effects last for approximately three months. However the functional benefits may last for longer, in some cases, up to one year after the injection.

The ideal frequency of re-injection in the paediatric population has yet to be established. In order to prolong the effect of the Botox, most paediatric centres limit their frequency of re-injection to a maximum of two injection sessions a year. Usually there is a re-injection interval of 6-12 months, unless specifically indicated for pain or acute dystonia interfering with function, which may require more frequent re-injection.

Age. There is no evidence to suggest that age is an absolute criteria for patient selection. Research supports positive results for Botox treatment at all ages, but generally younger children (< 8 years) are considered most appropriate. Younger children are considered more appropriate for BTX-A treatment as they are less likely to have established fixed soft tissue, bony abnormalities, or to have learned compensatory movement. Muscle selection Botox works by reducing the dynamic component of overactive spastic or dystonic muscles. Appropriate muscle selection is important to identify the specific muscles involved in causing the child’s primary functional problem.

Are there any side effects? The most common side effects reported are:

• Soreness at the injection site.

• Causes muscle weakness and in the short term may make balance and walking more difficult.

• Mild flu-like symptoms in the days after injections, which may be treated with paracetamol if necessary.

• Very occasionally, temporary difficulty with bladder control and swallowing.

Possible benefits of Botox treatment

• Improve walking

• Improve gross motor skills e.g. standing, transfers, sitting ability

• Improved tolerance of orthoses or casting

• Reduction in painful spasms

• Improved sleep pattern

• Improve personal care and hygiene

• Reduction in pain

• Improved quality of life