A few months ago, I blogged about an FDA safety warning for the use of Botox to treat spasticity in children. Since that time the American Academy of Neurology (AAN) has reviewed the medical literature on the subject, along with the literature that exists on the use Botox for dystonia. Their recommendation? That doctors should offer Botox to their patients who have Level A spasticity and cervical dystonia. (The AAN also made recommendations on Botox for other disorders, but that's beyond the scope of this blog.)
However, we've gone from a possible safety problem to an officially recommended treatment in 3 months. In their report on Botox for spasticity, the AAN makes a few disclaiming assertions and calls for more research on this treatment. Essentially they say:
- Botox is now standard treatment for movement disorders such as cervical dystonia and spasticity, but patients' response to this treatment has so far varied widely. So, as yet they do not fully know how it will affect you.
- A lot of injections are needed to to get the desired effects.
- At this point it is hard for them to tell if and how well Botox accomplishes the stated goals of treatment. This is especially true of those doctors who administer the therapy. In other words, Botox is now officially a standard treatment for spasticity and dystonia. In practice, however, a standard of care and expected outcomes all can agree upon is not yet in place.
- The technique the doctor uses when administering the injection is in need of further development.
- Information gleaned from reliable research studies concerning which muscles to inject and how much to give (dosage) did not yield all the necessary answers for a safe and effective Botox session at your doctor's office.
- The studies they reviewed didn't answer all their questions about the safety of having Botox injections over the long term. Also, they think there may be a possibility that a patient could develop resistance to this medication after a while.
- FDA Safety Warning on Botox for Spasticity
- Is Botox Safe?
- About Dystonia
- More Info on Dystonia
- Deep Brain Stimulation for Dystonia
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D. M. Simpson, J-M Gracies, H. K. Graham, J. M. Miyasaki, M. Naumann, B. Subcommittee of the American Academy of Neurology evidence-based review): Report of the Therapeutics and Technology Assessment Assessment: Botulinum neurotoxin for the treatment of spasticity. May 7, 2008
D. M. Simpson, MD, A. Blitzer, MD, DDS, A. Brashear, MD, C. Comella, MD, R. Dubinsky, MD, MPH, M. Hallett, MD, J. Jankovic, MD, B. Karp, MD, C. L. Ludlow, PhD, J. M. Miyasaki, MD, MEd, M. Naumann, MD and Y. So, MD, PhD. Assessment: Botulinum neurotoxin for the treatment of movement disorders (an evidence-based review) Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology