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Botulinum Toxin Injection   

     Botulinum toxin is FDA approved for use in the following diseases: Blepharospam/Strabismus, Cervical Dystonia, and Axillary Hyperhidrosis.  Botulinum toxin has also been used for decades in other medical situations with medical literature supporting its effectiveness.  Spasticity is one of the medical situations where botulinum toxin has been used for decades.

    Treatment with botulinum toxin involves one or several injections with a small needle, sometimes using electric stimulation or electric monitoring (EMG) to locate the proper muscles for injection.  The benefits can include improved range of motion, better control of movement, less pain, improved positioning and decreased spasticity.  The benefits are often temporary, usually lasting three or four months, occasionally longer. The maximum effectiveness of botulinum toxin may not occur until several weeks after the injection.  Therapy and splints may be recommended to maximize the effectiveness of the injections.

    The risks of botulinum toxin injection include loss of strength and muscle weakness all over the body, double vision (diplopia), blurred vision, droopy eyelids (ptosis), hoarseness or change/loss of voice quality (dysphonia), trouble saying words clearly (dysarthria), loss of bladder control (incontinence), urinary tract infection, allergic reaction or hypersensitivity (itching, rash, red itchy welts, wheezing, asthma symptoms, dizziness or feeling faint) , difficulty swallowing (dysphagia), dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, bleeding, bruising, local or systemic infection, upper respiratory infection, antibody formation, and anaphylaxis.

    Individuals taking medication that affects clotting or bleeding time are also at increased risk of bleeding from injections.  Antibody formation can also occur which could decrease the effectiveness of future injections.  Use of aminoglycoside antibiotics may potentially increase weakness.

    Botulinum toxin injections are not a successful treatment for dystonias or spasticity in all people.  Although physicians have been doing injections for several years, the dosages, treatment recommendations, and long term effects continue to be defined.  Injections will not be continued on a regular basis if there is no benefit to your function, care, and/or pain.

    The cost and frequency of visits may prevent some people from utilizing this form of treatment.  It is necessary to obtain insurance authorization prior to treatment for many insurance companies.  Some insurance companies still do not cover botulinum toxin injections.  Charges include the physician evaluation, the injection procedure, the medication, the needles and electric muscle monitoring (EMG) when necessary.  Our office will assist with the authorization process but patients remain financially responsible for those charges incurred which are not covered by the insurance carrier.

    If you would like to learn more about Botulinum Toxin A, please click here.

    If you would like to learn more about Boltulinum Toxin A for upper limb spasticity, please click here.