Botulinum toxin injections

What is Botulinum Toxin?

• Botulinum toxin is a chemical produced by bacteria which can be used, in minute quantities, to reduce the stiffness or tone within individual muscles.
• The toxin is diluted in salt water for injection into specific muscles.
• Once injected into the target muscle, the toxin spreads locally within the muscle and usually only affects the muscle into which it is injected.

Conditions suitable for treatment

• Spasticity (involuntary tightness of muscles) resulting in pain, stiffness and resistance to movement at the associated joints. Spasticity can result from brain and spinal cord injuries, stroke, multiple sclerosis and other neurological conditions.
• Dystonia (movement disorder in which muscles contract uncontrollably) and some cases of tremor.
• Excessive drooling seen in some neurological conditions like motor neurone disease, head injury and multiple sclerosis.

Benefits of treatment

• The toxin reduces the stiffness and pain in the affected muscles.
• For people who have spasticity, botulinum toxin injections can improve the range of movement and flexibility of the affected joint. Thus it may lead to improved sitting position, walking pattern and ability to perform daily living activities like hygiene, washing, dressing/undressing etc.

How long does it take to work?

• The toxin usually takes effect within 3 to 4 days of the injection but may take up to 2 weeks for the benefits to be seen. Generally the effect lasts for approximately 3 to 4 months following which the injections usually need to be repeated.

Does it work?

• Botulinum toxin injections are usually very effective for the conditions already mentioned. However, they are only effective in combination with stretches so patients must be prepared to implement an exercise programme alongside the injections.

Cautions for treatment

• People receiving anticoagulants, i.e. medication to thin the blood (warfarin, apixaban, rivaroxaban etc.), can be given Botulinum toxin injections with caution after a discussion of the likely risks/benefits.
• Botulinum toxin preparation contains a small amount of human albumin and though very unlikely, there is a theoretical risk of infection with blood borne viruses. This may also render it inappropriate for patients who are unable to receive any blood or blood products e.g. Jehovah’s Witnesses.

Side effects

• On rare occasions there have been complaints of flu-like symptoms such as headaches, fever and feeling tired or diarrhoea and vomiting. These symptoms are minor and do not last for long. A rash may also occur.
• Muscle weakness, which is temporary and usually affects the muscle injected. Very rarely distal spread of the toxin can occur and this may result in weakness in other muscle groups. Generalised weakness can however be severe enough to require hospitalisation, especially if your ability to breathe or swallow is affected. If this happens, seek urgent medical attention.
• Approximately 10% of patients given injections into the neck muscles experience a short lasting difficulty with swallowing. Once again, medical advice should be sought.

For further enquiries:

Medical Secretary – Lincoln County Hospital

Telephone:  01522 573926

Rehabilitation Medicine Outreach Team for North Lincolnshire

Telephone:   01522 573698

Rehabilitation Medicine Outreach Team for South Lincolnshire

Telephone:   01476 464971

Ashby Ward – Lincoln County Hospital

Telephone:   01522 572380

Available 9.00am to 5.00pm Monday to Friday.

Rehabilitation Medicine Service

c/o Occupational Therapy Department, Lincoln County Hospital