Of course, we have all heard of Botox because of its wrinkle reducing properties. But its benefits go beyond just making people look better. It can actually help them feel better too. Botox injections can reduce the spasticity of various muscles and body parts.
In the past, people who had upper and lower limb spasticity as a result of a stroke had limited treatment options. They received physical therapy, muscle relaxers, or other medications that had intolerable side effects. However, researchers determined low doses of Botox injections of 600 units to be a safe and effective treatment for this condition.
Because researchers saw some success with low doses of Botox, they wondered how patients would react to higher doses. Would higher doses of Botox yield more benefit? And could patients tolerate higher doses without side effects? This study used a Botox called incobotulinumtoxinA, which has no additional proteins. Therefore, the results cannot be extrapolated to other more complex forms of Botox. The lack of additional proteins lowers the risk that the body will react negatively or develop allergies to the injections.
Researchers in Italy evaluated 20 stroke patients over two years who underwent eight injections of Botox at regular intervals, usually 12-16 weeks apart. Most were suffering from severe muscle spasticity. In addition to measuring pain, researchers looked at limb position, dressing, and hygiene. They used the Disability Assessment Score or DAS in the evaluation.
The researchers used higher doses (up to 840 units) of Botox. They used the guidance of ultrasound or electrical stimulation identification of the affected muscle to ensure proper injection. That helps reduce the risk of spreading neurotoxins to other tissues and the bloodstream. In that way, they could avoid side effects like muscle weakness, dry mouth, and nausea.
The results of higher doses of Botox
In severe spasticity of muscles in the arm and leg, higher doses of Botox (up to 840 units) seem to be beneficial for improving the posture of arm and leg muscles and increasing the passive range of motion of the arm and leg joints. Patients reported improved muscle function, less pain, and fewer spasms, as measured by the DAS and other parameters. There were no adverse outcomes or side effects.
The authors concluded that this particular Botox was less likely to result in adverse reactions due to the purity of the strain, and this supports long-term, higher dose therapy to maintain improvement throughout the years of treatment. Of course, insurance companies may be reluctant to cover this therapy which makes it imperative that you and your doctor work together to make sure this is a good option for you. If you are not getting the results you want with conventional rehabilitation or if your condition is severe, then Botox could be for you.
The lead author of this study is Andrea Santamato, Physical Medicine and Rehabilitation Section, OORR Hospital, University of Foggia, Italy.