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DURHAM, N.C. -- Doctors at Duke Children's Hospital are
treating the tight muscles caused by cerebral palsy with Botox
injections. When given in combination with physical therapy,
the shots help patients strengthen their weak muscles and
restore normal movement.

The medication is injected into the muscles during an
outpatient visit. Although anesthesia is not required for Botox
injections, Duke pediatric neurologist Pedro Weisleder, M.D.,
Ph.D., teamed with Duke pediatric anesthesiologist Allison
Ross, M.D., to develop a system for sedating children with
inhaled anesthetics similar to the laughing gas used in many
dental offices.

"Children don't take well to needles or painful procedures,
and several parents asked if we could perform the injections
under anesthesia to eliminate their child's pain," said
Weisleder, an assistant professor of pediatric neurology at
Duke University Medical Center. "The end result is that the
procedure is painless and post-anesthesia recovery is rapid. It
also allows me to give more accurate injections," he said. To
identify the correct muscles for injection, Weisleder uses a
special needle through which he can both electrically stimulate
the muscles and deliver the medication.

The effects generally last about three months. During that
time, patients work with a physical therapist to stretch and
strengthen their weaker muscles. "Our goal is not to paralyze
the muscles, it is to rebalance them around the joints,"
Weisleder said.

In cerebral palsy, the brain loses the ability to moderate
the activity of contracting muscles. Muscles that produce
contraction are stronger than those that produce extension,
Weisleder said. Partially paralyzing the stronger muscles with
botulinum toxin gives patients an opportunity to stretch and
strengthen the weak muscles, he said. The long-term goal of the
two components of the treatment – injections and physical
therapy – is to achieve better muscle strength balance which
may lead to restoring normal function, Weisleder said.

Cerebral palsy encompasses a group of physical and movement
disorders that appear in the first few years of life. The
muscle spasticity and tightness caused by the disorder make it
difficult for people to perform fine motor tasks, such as
writing, and causes problems with balance and walking. Though
the disorder itself is not progressive, the consequences of the
muscle spasms worsen over time, Weisleder said. Spasticity can
interfere with daily activities and, in more severe cases,
cause significant pain and snap joints out of alignment.

Weisleder cautions that not every patient with cerebral
palsy will benefit from Botox injections, and the amount of
toxin a child can receive at each visit is limited by their
body size.