Medications
Physical Therapy
Medications
Medications to treat spasticity can be:
- Taken by mouth (oral).
- Injected with a needle (injectable).
- Released into the spinal cord (intrathecal) by an implanted pump.
Oral medications
Oral medications are effective in many patients and are safe to take long term. Because they enter the bloodstream, however, they can affect the entire body and cause some side effects, but these usually improve. Baclofen®, Dantrium® and Zanaflex® are commonly used oral medicines. Baclofen also can be given through a pump that is placed during surgery, called intrathecal baclofen (ITB) pump (see below).
Injectable medications
Injectable medications such as Botox®, Myobloc® and Phenol have been used safely for many years to reduce tone in specific muscles. Most times they are able to be injected right in the clinic. We use very small needles and often a numbing cream to cause very little discomfort.
Botox and Myobloc are medications that temporarily weaken muscles and prevents muscle fibers from contracting as much, making them looser and easier to stretch. In addition, they can:
- Allow a tight muscle to be more quickly and easily stretched.
- Allow a tight muscle to relax so the opposing muscles can get stronger.
- Help us to predict whether a muscle transfer might work.
- Help a person to gain better control over the muscle so a new skill can be learned.
- Make braces to fit better.
- Improve function and eliminate the need for surgery in some cases.
- Improve range of motion and reduce deformity.
Botox and Myobloc can be injected into any muscle, however they most often are used in smaller muscles such as forearms. It can take about three days before they work and their effect typically lasts for several months. Splints or casts may be put on right after the injections to help stretch the muscles. Physical therapy also is recommended in most cases after the medications take effect.
Because the amount of medication that can be injected depends on the size of the child, sometimes all the muscles that need to be relaxed cannot be injected at one time. In these cases, another medication, such as phenol also may be used.
Phenol is a medication that temporarily "uncoats" the nerves. Nerves have coating to help them transmit message quickly. When that layer is removed, messages travel more slowly, which is beneficial in children with spasticity.
The same benefits are seen with Phenol as with Botox and Myobloc, however Phenol takes effect immediately and lasts about six months. In addition, Phenol is better suited for big muscles such as the biceps, hips, knees and hamstrings.
Phenol needs to be injected close to the nerve, and can be difficult to get in the right spot so younger children may be sedated. Older children who can stay still can be injected in the clinic. |
