Botox injections to treat children with cerebral palsy

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Botox injections are best known for reducing wrinkles on the face. However, experts at Loyola University Health System are finding new ways to use the injections in children with cerebral palsy, with most benefit in patients who are younger than 5 years old.

“Children with cerebral palsy have very tight muscles, which get even tighter as the child grows,” said Dr. Deirdre Ryan, a pediatric orthopaedic surgeon at Loyola who has been using Botox injections in these patients for several years. Ryan also specializes in treating infant hip disorders, spina bifida, pediatric trauma and clubfeet, deformities of the ankles or the feet that are usually present at birth.

Traditionally, physical therapy is used to help relax the muscles of these patients. However, most of these children need multiple surgeries to lengthen their muscles. “Botox can help us avoid surgery or decrease the number of surgeries needed in some cases,” Ryan noted. “Botox also has helped some of these patients walk and care for themselves,” said Ryan.

Congenital cerebral palsy is a group of motor problems and physical disorders that result from brain injury or abnormal brain development that may occur during fetal growth or at the time of birth. An estimated 6,000 new cases of cerebral palsy occur in the United States every year. The condition leads to spasticity or tightness of the muscles and can be diagnosed as early as 15 months of age. The brain injury does not change but the tightness of the muscles gets worse over time, thereby interfering with day-to-day activities like walking, sitting and even the child’s hygiene.

Recent national figures indicate that the costs to maintaining the quality of life in these patients can be as high as $20 billion annually.

Botulinum toxin A (Botox) is the toxin responsible for a form of food poisoning called botulism. Paralysis is the most serious complication of botulism. However, the doses used to treat muscle tightness are very low with few side effects. Side effects may include weakness in the muscles at the site of injection. The weakness generally lasts for a period of three to six months. Local pain, redness or irritation occasionally occurs in the first few days following Botox injection. In addition, some children may experience a mild flu-like syndrome and fever after the injection.

Botox works by blocking the release of a substance the nerve uses to signal the muscle to contract. The injection treatments have proven useful in patients with muscle tightness because it temporarily relaxes the muscles. According to Ryan, the injections have been used for at least a decade to treat spasticity in patients with cerebral palsy and other neuromuscular conditions. Approval for this use is still being reviewed by the U.S. Food and Drug Administration.

The injection treatment is frequently used in combination with a cast, a technique that is used to improve the position of the extremities. If performed, casting usually begins one or two weeks after the Botox injection. Botox also is used in combination with ongoing physical therapy.

The treatment is injected into the affected muscles during a simple clinic procedure. Approximately one half hour before the injection, a numbing medicine is placed on the child’s skin at the injection site. A small needle is used for the Botox injection itself, which usually causes minimal discomfort. For very young children, anesthesia may be used. Almost any muscle can be injected. “However, since there is a total maximum dose than can be given to any child, based on that child’s weight, usually no more than two or three muscles can be injected at any one time,” said Ryan. “What’s best, the child’s activity does not need to be restricted after the Botox injection.”

The initial effects of the treatment are typically seen as early as three to five days after injection, with more visible effects seen by the first or second week. The effects generally last between three and six months. At that time, the nerve makes new fibers and resumes sending signals to the muscle to contract.


  1. Abhishek M.Choubisa Abhishek M.Choubisa India says:

    Dear sir / madam,

    Mr Daughter, Nitya is 3 1/2 years old and suffering from
    Cerebral Palsy.

    She is undergoing therapy since last one year, spasticity have been in moderate control and balance is improving gradually even though her knee extension in Gait is better than before. She is slowly developing a crouch pattern of walking.

    She is under supervision of Dr. Ashok Johari, Paediatric Orthopedic Surgeon, India.

    Soon we are starting her Botox treatment, as it is mentioned it gives Transient weakness, Swelling, bruising and calf pain, Skin rashes, Flue like syndrome. Asthenias, Urinary Incontinence are the
    some minor complication.

    If you can please help us with the precautions or steps to take, it will be helpful to tackle child's behavior.

    Thanking you.

    Awaiting for your feedback.

    Warm Regards,

    Abhishek M.Choubisa
    Mumbai, India
    +91 9820880685

    • drrajendra khaire drrajendra khaire India says:

      My own son at present 3yrs old is having mild CP affecting right lower extremity with recurvatum at knee, walks with intoeing gait and becomes toe walker while running. He was born premature at 6 n 1/2 months. He is under the treatment of Paediatric orthopaedic surgeon in Mumbai, India. And also being treated by Paediatric Physiotherapist at Mumbai. My wife herself is a Physiotherapist, and takes care of the Physiotherapy session at home. He has been advised Botox injection. Can u kindly guide ?

    • Alpesh  Jaiswal Alpesh Jaiswal India says:

      Dear Sir,

      My Son is 13 years old, He has cerebral palsy from born, Examined his mind one side block, He is running, walking, studying, & squealer student but his right hand is not working as like left hand, His right leg is slim,  tight muscles at addle his Addie straight. what is suggestion about botox injection for leg & hand

      Alpesh Jaiswal
      26, Ramkrishna Society,
      PIN 389 330 GUJARAT,
      PHONE NO. (R) 02676-235825, (O) 02676-235530    
      CELL NO. 9924339825

  2. Joydeep Sen Gupta Joydeep Sen Gupta India says:

    My daughter now 2 and a half year old, was born with an abrasion at the back of the head. Later we also found some deformities with her thumbs and little finger + she has this toughness in her leg muscles. All tests did not indicate anything. Her thumbs after being put in a cast is better. She does everything about 4/5 months later than other kids and is underweight, though active.

    She has tight muscles in her legs (thighs as well), does toe walking, walks with bent knees.

    After, we recently showed to a neuromuscular specialist, he has termed it as cerebral palsy and is suggesting use of botox injections.

    Request more information & understanding.

  3. Amanda Smith Amanda Smith United Kingdom says:

    Hello. My sone is nearly 3 and had botox injections in his hamstrings, calf muscles in January. He walks with a crouch gait on his toes and is unable to sit independantly. Whilst he was under anaesthetic for the botox he had casts made of his legs for splints to keep his ankles at 90 degrees. Following botox ther were no side effects at all and he was able to maintain flat feet much better. He had this done privately in Australia. I am however struggling to find someone to repeat the procedure now in the UK. Amanda

    • steve Ketteringham steve Ketteringham United Kingdom says:

      My daughter is 3 and a half, she has been seen by Dr Meddan at doncaster royal Infirmary today - orthapedic surgeon, my daughter is to receive botox injections at his clinic in Sheffield (not sure which hospital maybe childrens hospital or sheffield and hallamshire. I read they carry this procedure out at Alder Hey at Liverpool.

      Hope this helps

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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