Times of India
17 February, 2010
By Pratibha Masand

Growing No. Of Private & Civic Hosps Are Using Botulinum Toxin To Help Kids With Mild Cerebral Palsy
For a growing number of people, botulinum toxin or its more popularly known trade name, Botox, is a handy tool to erase pesky wrinkles and stop the clock, temporarily. But for another section of society, Botox is the answer to treating spasticity among differently abled children–a procedure that is finding acceptance not only by paediatric orthopaedics, but also neurologists in the private and public health care sectors.

Many children suffering from cerebral palsy, for instance, tend to walk on their toes due to spasticity of their ankle muscles. Others experience knee bends and jerks while walking. But botulinum toxin, along with physiotherapy, can relax muscles and thus enable the child to walk almost normally without the need for surgery.

“Cerebral palsy is a group of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination. Here, the brain sends disorderly impulses through the body. A shot of botulinum toxin in the area of the spasticity locks the chemical that causes the transmission of these disorderly impulses, and the muscles relax,” said paediatric orthopaedic surgeon Dr Ashok Johari, who has been using this technique for over five years.

This treatment has also found favour among parents, as if successful, it eliminates the need for surgery. As a toddler taking his first footsteps, six–year–old Ritik Bhandari always walked on the toes of his right foot, and experienced strange jerks in his knee every time he took a step. He also experienced awkwardness in hand control in the same side of the body. “Initially, we thought that surgery was the only way to fix it. But then we tried a shot of botulinum toxin and with the help of physiotherapy, he started walking normally, said Johari, who is associated with a number of hospitals including Lilavati in Bandra. Success was not instantaneous, but two years in the making. To date, Ritik has not needed a second shot, and his muscular movement in his right hand has also been restored to normalcy. But results of the effect of Botox on muscles vary from case to case and depends on the severity of spasticity, caution doctors. “When the botulinum toxin is working on the muscles, and with the help of physiotherapy, the brain is trained to not send disorderly impulses. So even when the effect of botulinum toxin wears off, most of the time, the muscles do not go rigid again,” said Dr Mohit Bhatt, head of neurosciences department in Kokilaben Ambani Hospital, Andheri.

Though the treatment is not cheap–anywhere between Rs 7,000 to Rs 15,000 per shot –it’s not just limited to private sector hospitals. The civicrun KEM Hospital in Parel offers patients a shot at botulinum toxin. “We get an average of 13 cases per month for various botulinum toxin treatments. We even have a separate lab for these treatments, which are equipped with electromyography machines that help in detection of over–active muscles and also inject the shots,” said Dr Yogesh Godge, neurosurgeon at KEM.

Easing Muscular Disorders
What Is Cerebral Palsy?
Cerebral Palsy is a neurological muscular disorder that appears during infancy or early childhood. It permanently affects body movement and muscular coordination. Simply put, the brain of a child suffering from cerebral palsy transmits disorderly impulses

Can Botulinum Toxin Help?

• Botulinum toxin (Botox) when injected into the affected muscle group, locks the chemical that causes transmission of impulses
• With the help of physiotherapy, over time, the brain can be taught not to send these impulses even when the effect of botulinum wears off
• Its success depends on a number of factors like the age of the child and severity of the spasticity of the muscles. When spasticity is quite severe, surgery may be the best option

Incidence

• 3 out of every 1,000 newborns have cerebral palsy
• Botulinum toxin DOES NOT cure cerebral palsy