SPASTICITY-BOTULINUM TOXIN

SUMMARY

1. All 7 serotypes affect the NMJ, blocking NM transmission by inhibiting the pre-synaptic release of ACh.

2. Onset of action: 4-10 days.

3. Length of effect: 3-6 months (3 days initial effect, 3 weeks peak effect, 3 months duration).

4. Optimal injection is guided by nerve stimulator or by seeking the motor end-plate using an EMG; has been shown to optimize the resulting paralysis.

5. Effect is reversible due to axonal sprouting proximal to the nerve terminals and formation of new neuromuscular junctions in 3-6 months.

6. Guidelines suggest a dose no larger than 600U to prevent adverse effects and antibody development.

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.