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Veterans with Traumatic Brain Injury Find Botox a Surprising Answer for Painful Muscle Spasms

March 22, 2010

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Stephanie Sneed, M.D., Polytrauma/Traumatic Brain Injury Program director injects Air Force Veteran James Cunningham, Jr. with Botox to treat muscle stiffness and spasticity in his arm muscles. PHOTO: Bobbi Gruner, Public Affairs Officer


HOUSTON - Botox is the brand name for therapeutic botulinum toxin, an ultra purified neurotoxin. Most people know Botox as a cosmetic treatment for facial wrinkles and aging of the skin; however, this special medication is also used by health care providers to treat increased muscle stiffness in adults with upper and lower limb spasticity.

Spasticity is a debilitating condition impacting many Veterans following a spinal cord or traumatic brain injury. An estimated 300,000 Veterans have sustained some type of traumatic brain injury from explosions and blasts in the wars in Iraq and Afghanistan.

Although not a life-threatening condition, limb spasticity can be severely debilitating and painful, producing disfiguring muscle contractions that can result in stiff, tight muscles. This stiffness hinders a patient’s ability to perform simple tasks, such as dressing or washing. It can also hinder a patient’s ability to walk, and often leaves the patient bedridden and dependent on a caregiver to help with simple activities.

When injected into muscles that are in spasm (also known as involuntary contractions), botulinum toxin is a complex protein that binds to the nerves and prevents the release of a neurochemical, acetylcholine. This blocking action reduces the spasm of the muscles and produces a temporary paralysis of the nerve function. The medical term for the Botox injections is chemical denervation.

“The purpose of the procedure is to assist patients in facilitating their rehabilitation goals and to reduce the pain caused by intense spasms,” said Stephanie Sneed, M.D., Polytrauma/Traumatic Brain Injury Program director. “We find the use of Botox extremely helpful in improving a Veteran’s quality of life.”

Sneed, together with fellow Physical Medicine and Rehabilitation Specialist Darlene Makulski, M.D., treat an average of 40 patients each month with the Botox medication. Patients may be injected in multiple sites depending on the location and intensity of their spasms and pain. Patients receive almost immediate relief from their painful spasms because the medication works within 48 to 72 hours and reaches its peak effect at one to four weeks.

Just this month, the U.S. Food and Drug Administration approved Botox to treat spasticity in the flexor muscles of the elbow, wrist, and fingers in adults.

“We strive to offer our Veterans the latest medical advances. Botox is just one tool of many that we use to treat our Veterans living with painful muscle spasms and other rehabilitation challenges,” said Helene Henson, M.D., Rehabilitation Care Line director.



Doctor uses Botox to treat brain injury damage

Monday, April 12, 2010

HOUSTON (KTRK) -- A traumatic brain injury can cause drawn muscles in the arms or legs, and painful muscle spasms. But one Iraq veteran suffering from a brain injury is getting help - from Botox.

Adrian Olivarez was an Army scout in Iraq.

"Me and my buddies were like, 'Just pretend that you're already dead, you know,'" Olivarez said. "And being dead, it makes you not care because it can happen in the blink of an eye."

It happened. Not in Iraq, but here in a car accident.

Bleeding in his brain caused his right hand to stay clenched and the muscles of his right arm and leg to stay tight and unable to move. "When he tries to move his arm, the wrong muscles are firing," said Dr. Darlene Makulski, a rehab physician with the DeBakey VA Medical Center. Dr. Makulski gives him Botox shots to loosen the muscles that keep his arm tight and hand clenched. "It's gonna be way looser, you know, and for the arm, it's gonna be way better," Olivarez said. Dr. Makulski injects more than 24 shots in his arm, and leg. It helps his movement and the pain of constant muscle contractions.

"This is helping improve his quality of life, reintegrate him into the community and give him an overall sense of independence," Dr. Makulski said. After two weeks of treatment, Olivarez's hand can open and close enough for physical therapy. "Before it was hardly anything, but now, it's move (my hand) down and up," he said.

His right arm can hang on his side more naturally. He still lifts his right leg but the walking is better. Sensors around his neck, knee, and on his ankle also help him walk.

How far will Botox and therapy take him? He doesn't know yet. "I live everyday at a time, you know?" he said.

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