The more I know, the less I know.
Botox injections become extremely popular in cosmetic and medical use. But what has me worried these days is its increased use in children with hyper tone cerebral palsy. In fact, almost every day in my practice, I hear about another child whose doctor has recommended Botox injections. And I ask myself: Why – what for?
But, let’s just step aside for a moment to analyze the Botox injection itself and its supposed “local effect.” Botox is derived from the botulinum toxin, a neurotoxin that interferes with nerve impulses and causes muscle paralysis – including breathing disorders leading to death – muscle weakness, speech disorders and swallowing problems. Depending on the introduction of the botulinum to the human body, 90 to 270 nanograms of this toxin is enough to kill a person weighing 200 pounds or 90 kilograms.
Botox itself contains a very small dosage of botulinum toxin. Interestingly enough, the American Food and Drug Administration cautioned about the use of Botox in children – a warning it reissued in April 2009. Moreover, the FDA did not approve Botox injections as a treatment for spasticity in children. In a document called Early Communication about an Ongoing Safety Review of Botox and Botox Cosmetic (Botulinum toxin Type A) and Myobloc (Botulinum toxin Type B), the FDA states that it is “aware of the body of literature describing the use of botulinum toxins to treat limb spasticity in children and adults. The safety, efficacy and dosage of botulinum toxins have not been established for the treatment of limb spasticity of cerebral palsy or for use in any condition in children less than 12 years of age.”
The FDA goes on to say that “the pediatric botulism cases occurred in patients less than 16 years old, with reported symptoms ranging from dysphagia to respiratory insufficiency requiring gastric feeding tubes and ventilatory support. Serious outcomes included hospitalization and death. The most commonly reported use of botulinum toxin among these cases was treatment of limb muscle spasticity associated with cerebral palsy.” You can read the FDA’s comments in full at http://www.fda.gov.
Yet in Canada, Botox injections have been approved as a treatment for children with hyper tone cerebral palsy and other neurological disorders. As a practitioner, I have read accounts about “the whole world of abilities” which Botox injections have given to one child or another. Personally I have seen quite a few children after they’ve received Botox injections and have not seen any improvements. In some cases, I saw even deterioration.
The spasticity and / or hyper tone come from the central nervous system or the brain. Each child is born with hyper tone, but this tone becomes balanced and normal coordination of movement is built up when the child starts to move his or her head, roll from side to side and develop. The child who does not experience this “normal development” is developing abnormal “hyper or hypo tone.” In other words, this child is in the “evil circle” of inability to move functionally, which in turn leads to hyper or hypo (low) tone.
In my professional and personal opinion, the most important thing is to teach the child all functions all the time. This constant learning will normalize the child’s tone. If there is spasticity, followed by deformation of the joints, then there may be a place for Botox in your child’s treatment program. But keep in mind that there is no such thing as “local injection.” Any agent injected into the body will be absorbed and distributed by the blood throughout the whole body.
So given all this, before you to decide to allow your health practitioner to use Botox on your child, please consider your child’s age and condition and what gains your child stands to make as a result of the injection. And don’t forget that the effects of Botox wear out over time and that your child would need repeat injections at regular intervals.
Most important of all, keep in mind that Botox injection is not a simple, harmless shot. It does pose health risks for your child. The decision is yours, so make it wisely.