1. History of Botox
In 1895, all 34 members of a club in Belgium developed clinical symptoms characterized by nerve paralysis within 36 hours after consuming cured ham. At that time, Clostridium botulinum was detected from both humans and food, so the disease was called botulism (Botulism).
Botulinum toxin is a toxin produced by the anaerobic bacterium Clostridium botulinum and is classified into 7 types (A, B, C1, C2, D, E, F, G). All of them are neurotoxins, except C2 which is a cytotoxin. The toxin type A (Botulinum toxin A) is the most toxic, the most stable, easy to prepare, and can be stored for a longer period of time at low temperature, and was approved for production by the FDA in December 1989 (BOTOX). It was produced in China in October 1993, and the state gave it a pharmaceutical license in 1997 (Hengli). Dang Weili, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
1978Scott in the US received FDA approval for testing in humans (blepharospasm, hemifacial spasm)
1984MF Brint Used to treat blepharospasm, hemifacial spasm Slanting neck, laryngeal dystonia, writing spasms, etc.
Approved by Chinese SFDA for frown lines on February 11, 2009, it is widely used in the cosmetic industry for wrinkle removal, face and body slimming, etc.
In 1997, Professor Huiying Liang of the Rehabilitation Department of the Second Hospital of Hebei Medical University first used domestic injectable botulinum toxin type A (BTXA) for pediatric cerebral palsy, and achieved good results with rehabilitation training.
Currently, 61 countries around the world have officially approved BOTOX for the treatment of cerebral palsy in children.
The Pediatric Cerebral Disease Treatment and Rehabilitation Center of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine took the lead in the province to carry out neurostimulation-guided botulinum toxin A injection technology in 2006, and more than 200 cases have been injected so far with good efficacy and no adverse reactions.
2. Mechanism of action
Botulinum toxin acts on peripheral nerve endings, nerve-muscle contact points, i.e. synapses, and inhibits the release of acetylcholine from presynaptic membranes to cause relaxation paralysis of muscles, thus playing a therapeutic role in relieving spasm and tonicity.
3.Botulinum toxin injection
About 70% of children with cerebral palsy have spastic cerebral palsy. Spastic cerebral palsy is characterized by increased muscle tone, resulting in motor dysfunction, so reducing muscle tone and promoting motor development is the focus of treatment. By injecting Botox, muscle spasm can be relieved quickly and muscle tone can be reduced. However, botulinum toxin injection is very demanding.
3.1 Case selection
Age 1-5 years old, with certain motor function, autonomous motor ability, spastic cerebral palsy or tardive cerebral palsy with focal muscle spasm and dysfunction is preferred, and no heart, liver, kidney and blood system diseases, no fever and no infection are applied.
3.2 Timing of injection
When the child is able to stand or walk alone, but has abnormal walking posture due to increased muscle tone, Botox can be injected to reduce muscle tone and improve abnormal posture. If a child is unable to take care of himself/herself due to increased muscle tone, Botox can be injected to reduce muscle tone to facilitate care or nursing. Or, by reducing muscle tone, it can provide a strong basis for rehabilitation training.
3.3 Injection site selection
A detailed functional assessment of the child by the physician is required to identify the muscles that cause increased dysfunctional muscle tone as the target muscles for injection.
3.4 Injection method
In many cases, blind injection is done with bare hands, which has the advantage of short injection time and relatively little pain for the child, but the disadvantage is that the injection site is not always accurate and affects the efficacy. The botulinum toxin A injection technique under the guidance of neuroelectric stimulator carried out in our center has the characteristics of simple operation, accurate positioning and remarkable efficacy, but the disadvantage is that the child will experience pain.
3.5 Injection dose
6-12 units/kg. By assessing the different severity of spasm of each target muscle and the different size of the muscle, the drug is reasonably distributed to achieve the best therapeutic effect.
3.6 Post-injection treatment
After botulinum toxin injection, it is very important to strengthen the rehabilitation functional training. After botulinum toxin injection, the effect usually appears about 2 days after injection, reaches the maximum effect from 4 days to 1 week, and the effect is maintained for 3-6 months. The drug only provides the opportunity for rehabilitation treatment within a time period, without post-injection rehabilitation training, the drug injection is just a waste of money. After injection, training should be strengthened, massage, exercise therapy, spastic muscle physiotherapy, etc. For some appearing joint deformation or to prevent joint deformation, suitable orthopedic brace should be worn after injection to correct, reduce or prevent joint deformation.
4.Adverse reactions
Botulinum toxin is very toxic, 1g can kill tens of thousands of people, but it is not toxic to neuromuscular. The only indicator to decide whether Botox is an angel or a devil is the dosage. Botox as a drug, each bottle contains 100 units, equivalent to 5ng, 1ng = 10-9 g; intravenous injection of 3000 units can cause the death of 70kg adults. The injection of botulinum toxin in children with cerebral palsy mainly acts locally and rarely spreads to the blood, and the dosage is very small each time (6-12 units/kg), so except for pain during injection, adverse reactions are rarely found. So far, more than 200 cases have been injected in our center, and no adverse reactions have occurred in any of them.
Botulinum toxin is the most dazzling means of treating spasticity and hypertonia, and botulinum toxin injection is a technique, but also an art. Proper application can achieve immediate results.