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Botox Helps Stroke Victims

Injection relieves debilitating muscle spasticity

WEDNESDAY, Aug. 7, 2002 (HealthDayNews) -- The wrinkle-removing use of Botox gets all the ink, but its real medical value is to help relieve some major neurological problems, ranging from facial spasms to writer's cramp.

Now neurologists are reporting another success -- relief of the wrist and finger difficulties that plague many stroke patients.

"This is the first study to show that Botox improves function and quality of life for these patients," says Dr. Allison Brashear, an associate professor of neurology at Indiana University School of Medicine and lead author of the report in tomorrow's issue of The New England Journal of Medicine. "Until this, people thought, 'It just loosens muscles. So what?' The important statistic in our study is that 62 percent of the patients had improvement in the goal they wanted to achieve."

The patients, 126 of them, had suffered strokes that created painful and impairing spasticity of their hands and fingers. The tightness was so bad that many patients had trouble with the menial things in life, such as dressing themselves. Drugs such as diazepam give some relief, but they affect the entire body and cause side effects, most notably sleepiness. In the multi-center study, half the patients got an injection of 240 units of Botox -- at least 12 times greater than the dose used for wrinkles -- and half got a placebo.

Over the next 12 weeks, the participants were asked to rate their progress on one of four criteria they picked for themselves: improvement in personal hygiene, dressing, limb position or pain. It was a clear win for Botox: 62 percent of Botox patients reported improvement, compared to 27 percent of those who got the placebo.

Officially, Botox -- the brand name for botulinum toxin A, which relaxes muscles by inactivating the nerves that control them -- is not approved by the U.S. Food and Drug Administration (FDA) for this purpose. "It is an off-label use, but Medicare and most insurance programs cover the treatment," Brashear says.

Among the neurological uses of Botox that do have FDA approval are relief of spasms of the face, neck, back and feet, says Dr. Mark F. Gordon, an associate attending physician in the neurology department of Long Island Jewish Hospital who took part in the study.

"I have been injecting it for those problems for more than 10 years," Gordon says. There is a standard technique, he says, with an initial injection whose effect usually lasts about three months, followed by more injections to renew the effect.

The new study describes its use in what is "a relatively common problem after motor strokes," he says. "If a limb is paralyzed after a stroke, spasticity can develop months or years after the stroke."

There is one potential problem from repeated Botox injections, Gordon says. "It is possible to develop antibodies that cause resistance to the medicine, so that the body fails to respond to it. It is probably a risk in a few percent of patients. I haven't seen it yet in injections for stroke."

That problem is trivial compared to the benefit of Botox injections, he says. "The advantage of using Botox is that you can locally target the muscles that need treatment," Gordon says. "That avoids the systemic side effects, especially brain-related effects such as dizziness and sleepiness."

So while wrinkle relief may be the attention-grabber, "most Botox used in this country is for neurological problems," Brashear says. "You can put it right where the problem is."

The study was supported by Allergan, the maker of Botox, and many of the researchers have or had financial ties to the company.

What To Do

You can get a briefing on Botox for wrinkles and neurological problems from the U.S. Food and Drug Administration. Learn more about brain attacks and their aftermath from the National Stroke Association.

SOURCES: Allison Brashear, M.D., associate professor, neurology, Indiana University School of Medicine, Indianapolis; Mark F. Gordon, M.D., associate attending physician, neurology department, Long Island Jewish Hospital, New Hyde Park, N.Y.; Aug. 8, 2002, The New England Journal of Medicine
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