BOTOX Injections Work for Post-Stroke Spasticity, Improve Patient and Caregiver Quality of Life
By: Diana Barnes-Brown for Veins1
New research recently sponsored by Allergan, Inc., the makers of the botulism toxin based BoNTA they sell as BOTOX®, has demonstrated that in addition to the cosmetic benefits coveted by those who can afford the sessions (which run about $350 on average), BoNTA injections have benefits for those suffering from actual medical disorders.
|If you notice any of the following symptoms of stroke, call your doctor IMMEDIATELY.
These symptoms are signs of both stroke and other potentially life-threatening neurological problems, and the sooner they are treated, the better the chances of recovery:
Sudden, often one-sided, weakness or numbness in the face, arm or leg
Vision changes or difficulty seeing
Sudden confusion, difficulty speaking or difficulty understanding others’ speech
Sudden difficulty walking or standing, trouble keeping balance, and poor coordination
Sudden severe headache that seems to have no specific cause
Specifically, stroke patients suffering from spasticity (involuntary or uncontrollable shaking) in their upper limbs showed considerable improvement when treated with BoNTA injections, leading to improved functioning for patients and better quality of life for both patients and their caregivers.
According to the American Heart Association and the journal Clinical Rehabilitation, spasticity occurs in 19 to 38 percent of stroke patients when muscles or muscle groups in a region of the body are overactive, causing them to become tight, difficult to relax, uncomfortable and often compromising their functioning. Spasticity in the hands or wrists can be particularly disruptive to patients’ lives because it interferes with basic daily activities such as buttoning clothing, performing basic daily hygiene rituals, writing, dialing a phone, or using keys. According to the National Institutes of Health, roughly 600,000 strokes occur every year in the United States alone, meaning that between 100,000 and 200,000 suffer from some degree of spasticity.
For caregivers also, the impact is huge because the lack of these basic abilities can cause them to spend many additional hours helping the people in their care with these basic tasks. This work is in addition to the many other steps of neurological, physical, and psychological rehabilitation required. The time and constant involvement required on caregivers’ parts in such situations can cause psychological, financial, and physical stress.
The study was led by Elie Elovic, M.D., Director of Traumatic Brain Injury Research at West Orange, New Jersey’s Kessler Medical Rehabilitation Research and Education Corporation. Elovic and her team researched the effects of BoNTA on 279 patients who had had strokes at least six months before the beginning of the study period. The patients came from 35 different treatment centers. The researchers gathered data with standard, validated scales and also with the use of questionnaires completed by patients, physicians and caregivers.
Patients were given injections to block the nerve activity responsible for muscle spasticity in the upper limbs. At week six of the study, stroke patients’ muscle tone in the areas treated with BoNTA was much lower, meaning that muscles were less tense and much closer to normal functioning than before. These improvements held steady for the course of the one-year research period.
Patients also reported that their functional disability had improved after receiving the treatment. They answered questions before their first treatment, indicating which of four areas of functional disability – hygiene, dressing, limb posture and pain – was most important to them, and were asked to rate their disability in this area on a scale of one to four. Roughly 50 percent of the patients treated with BoNTA for the study reported a 1-point improvement or better in their chosen area.
On the pretreatment questionnaires, 57 percent of the patients reported being moderately, quite a bit, or extremely impaired in their mobility and walking because of the spasticity in their arms; also, 79 percent said they had difficulty performing work activities because of their impaired upper limb functioning. After receiving BoNTA treatments, 46-49 percent of this group noted improvements in walking and mobility, while 44-51 percent noted improvements in their productivity at work.
Patients were less dependent on their caregivers to get through the day as well. Before receiving BoNTA treatment, they needed an average of 26.2 hours of assistance by friends or family members every week, and caregivers took an average of 2.5 days out of work per month to assist. After treatment the number of hours assistance was reduced, and missed work days were reduced to 1.5 on average per month.
While 6.5 percent of patients did report muscle weakness and pain in the treated extremities, no serious adverse effects were reported as a result of the treatment: “the low incidence of adverse events associated with BoNTA treatment in this year-long study suggests that BoNTA may represent a clear advantage over many oral anti-spasticity medications,” which have many side effects including drowsiness, dizziness, and muscular weakness, noted Elovic.
"In this study, treatment with BoNTA benefited patients on several fronts. It significantly reduced spasticity in the wrist, fingers and elbow; and improved patients' ability to perform activities related to work as well as daily living, such as bathing, dressing, and mobility,” stated Elovic, and with these improvements occurred “statistically significant decreases in the number of hours per week patients required assistance, improving the quality of life not only for patients but also for caregivers."
Since shortly before the turn of the last century, botulism toxin has been injected to help with certain kinds of muscular spasticity, such as that associated with cerebral palsy, but it received the most media attention as a miracle cure for the facial wrinkles naturally associated with the aging process. The National Institutes of Health report that stroke is the leading cause of disability for those over 65.
With numbers like these, BoNTA, which had previously been relegated to the realm of beauty queens and pursuers of endless youth willing to pay the price, may soon gain wider acceptance as a legitimate medical therapy.