How long does Botox for muscle spasms last?

How long does Botox for muscle spasms last?
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If onabotulinumtoxinA, a neurotoxin derived from a type of bacteria called Clostridium botulinum, is a term you’ve never heard before, you’re not alone.

Otherwise known as Botox Cosmetic, this prescription medication is used to temporarily paralyze facial muscles and help make moderate to severe forehead lines, crow’s feet, and frown lines less noticeable.

Considered a relatively safe and straightforward procedure, according to a 2016 study, you can typically expect to see and feel the full effects of Botox 10 to 14 days after the procedure.

We talked with a few experts to find out how long it takes for Botox to work and how long you can expect to see and feel results.

In general, you can see the effects of Botox as early as 3 to 4 days after an injection. Dr. Oscar Trujillo, a facial plastic surgeon at Columbia University Irving Medical Center, says most patients will see results within 10 to 14 days but should wait the full 14 days to see the maximum results.

While the results vary based on factors such as the area treated and frequency of injection, Trujillo says results generally last 3 months.

In addition to the area treated and frequency of injection, the timeline of efficacy is also affected by the dose of Botox. According to Dr. Melanie Palm, a board-certified dermatologist and cosmetic surgeon, it appears that the higher the dose given in an area, the longer the effect on the muscles.

“Therefore, lighter dosing that looks most ‘natural’ may last only 6 to 8 weeks, while heavier dosing (more units) could last more than 6 months but ‘paralyze’ the appearance of muscles, such as the frown lines,” she said.

Because of the difference in results, Palm says this delicate balance between dose, desired look, and duration is something you should discuss with your healthcare provider prior to treatment to set proper expectations.

The most common areas of the face for Botox include the forehead, around the eyes (crow’s feet), and between the eyebrows. In general, Trujillo says the finer the lines, the faster the results.

“For example, patients will generally see results more quickly in areas such as the corners of the eyes (crow’s feet) and fine forehead lines,” he said.

However, Trujillo says the results may take longer for areas where the lines are deep or etched. “This includes the lines between the eyebrows or very deep or etched forehead lines,” he said.

Moreover, Palm says it’s not that Botox injected in different areas takes different amounts of time to see results — it’s really the concentration of product injected and how it’s injected into the muscle that determines the ultimate effect.

That said, “It is possible that larger muscles receiving less units (think forehead) may appear to kick in slower than a smaller muscle (a weaker frown) receiving more units,” she explained.

While some results are noticeable after 3 or 4 days, it can take a few weeks to see maximum results. Why this delay?

Botox binds at a connection point between muscles and nerves called the motor endplate. When this happens, Palm says the nerves “bark orders” at the muscle to move, and the motor endplate of the nerves, which is the megaphone, hollers at the nerve to contract.

“Botox binds to a specific protein called SNARE at the motor endplate that sends chemical messages (the shouting protein, aka, acetylcholine) to tell the muscle to move,” said Palm.

Botox silences this game of telephone, and without the chemical acetylcholine being released, Palm says the muscle doesn’t move.

Although Botox binds quickly, Palm says the shutting off of SNARE, and the silencing of acetylcholine takes several days. This explains why the onset of Botox isn’t immediate, but rather takes several days.

“Botox is administered by injection under the skin, where it is absorbed by nerve cells in contact with the muscle,” said Trujillo. In very basic terms, Trujillo says it takes time for Botox to take effect on the muscle and stop or weaken the muscle contraction that causes the lines and wrinkles to appear on the surface of the skin.

“Once those muscles stop contracting, the lines or wrinkles release, resulting in an improved appearance of the skin,” he added.

It’s working when your lines start to fade away. “The treated area will appear smoother and look more refreshed,” said Dr. Sapna Palep, founder of Spring Street Dermatology.

After your first treatment, Palep says you may feel a slightly tight sensation or a feeling of heaviness, which will subside in 1 to 2 weeks. You can typically tell that Botox is starting to wear off when you can see dynamic lines again with movement.

When it comes to finding a provider to administer Botox, the first criteria is to go with a board-certified physician. Commonly, people will seek treatment from a board-certified dermatologist or plastic surgeon.

To find a board-certified dermatologist, you can search using the American Academy of Dermatology’s Find a Dermatologist tool. If you’re looking for a board-certified plastic surgeon, you can use the American Society of Plastic Surgeons’ Find a Plastic Surgeon Near Me tool.

When in doubt, talk with your healthcare provider about referrals in your area.

Making the decision to get Botox injections isn’t something you should take lightly. While the procedure is simple and generally considered safe, it’s still an elective procedure that comes with risks.

Knowing the risks ahead of time, as well as the proper dose and timeline to meet your needs, can help you make an informed decision.

NOTE: The use of Botox for cerebral palsy patients has not been approved by the FDA and is considered an off-label use.

Spasticity, or muscle stiffness, is a common problem for children with cerebral palsy. Spastic muscles are tight and make all movement difficult. Consequently, spasticity can interfere with many motor activities including sitting, walking, feeding, talking and play. Oral and injected medications are helpful in treating cerebral palsy spasticity. Oral medications are effective in treating mild spasticity. Since these medications cannot be directed to a specific area of spasticity, patients with significant spasticity can be treated with injected medications such as Botulinum type A toxin (Botox®). Your physician may elect to use other injectable drugs such as Myobloc (Botulinum Toxin B) and Dysport (Botulinum Toxin A) which have similar effects and side-effects as those listed below. They will inform you if this is the case.

What is Botox?

Botulinum-A Toxin is a substance made by bacteria. This toxin can be purified and used safely and effectively to reduce spasticity in specific muscle groups. Botox works by blocking the chemical signal between nerves and muscles that makes the muscle contract or tighten. This provides reliable relief from spasticity symptoms including pain and muscle stiffness. It has been used safely in thousands of patients for over 25 years.

What are the benefits of Botox?

The benefits of Botox include:

  • Significantly improved gait pattern.
  • Improvement in positioning and range of motion.
  • Decreased pain in stiff muscles.
  • Reduction of spasticity and greater ease in stretching.
  • Improved tolerance of braces.
  • Possible delay in surgery until the patient is older.
  • Improved independent use of the upper extremities for ADL completion.
How long does Botox for muscle spasms last?

How is Botox administered?

Prior to the injections:

To get the best effects from Botox your physician will inject the botox directly into the affected muscle group. Since this procedure involves multiple needle injections, all efforts are made to minimize anxiety and discomfort including:

  • Ethyl Chloride: All patients will have a “freezing spray” used on the area to be injected.
  • Oral versed-If requested by the patient or family, this drug is given prior to the procedure by mouth to reduce anxiety and provide amnesia for the procedure. When versed is given, vital signs are taken before and after the procedure and additional monitoring may be required. The medication takes about 20-30 minutes to take effect. The patient cannot go to school and must be under the care of an adult the day of versed administration. If the patient has a G-tube, it is imperative that you bring the G-tube connector for Versed administration.
  • Bringing things from home: You are welcome to bring something from home that is comforting including, music, a special blanket or a favorite toy. Parents/care providers are encouraged to remain with the patient during the procedure.

The injection procedure:

If requested, versed is given prior to the start of the procedure. Once the physician is ready to administer the Botulinum Toxin, they will identify which muscle groups need to be injected. These areas are cleaned with alcohol and the “freeze spray” is applied. The physician will then administer the Botulinum Toxin using a small needle. The number of injections will depend on the size of the muscle and the total number of muscles to be injected. The actual injection procedure will take just a few minutes. After the injections are completed you will be given specific instructions regarding follow up.

What happens after the Botox injection?

After the Botulinum Toxin the patient may return to normal activities. If the physician has ordered serial casting to help stretch the muscles after the Botulinum Toxin injections, these casts will be placed in approximately one to two weeks. A change in the patient’s physical therapy program may also be requested to meet specific goals.

Most patients start to see results from the Botulinum Toxin within five days with maximum results between three to four weeks after the injections. Usually, Botulinum Toxin provides relief of spasticity in the injected muscle for over three months at which time the patients begin to notice a gradual fading of its effects over several weeks. At this point the physician can give another treatment. Botulinum Toxin cannot be given more frequently than every three months.

It is imperative that the patient return for their scheduled follow up appointment after the Botulinum Toxin is given so we can document the benefits of the Botulinum Toxin given and determine if another treatment is needed.

What are the side effects of Botox?

Side effects are generally transient and well-tolerated. The most common side effects (with an incidence of less than 10 percent) are:

  • Temporary weakness to the extremity where the Botox has been given.
  • Temporary general weakness.
  • If given in the lower extremities (legs), falling may occur. This may be due to the change in ankle position, gait pattern or local weakness.
  • Localized injection site pain. If this occurs, the patient may take Motrin or Tylenol. An ice pack to the injection site may also help. This should be resolved in just a few days.
  • Localized injection site infection.

If you or your child have any of the following Botulinum Toxin cannot be administered:

  • Fever, cough, cold or flu like symptoms
  • Immunizations received within the last week
  • Scheduled to receive immunizations within 7 days after Botulinum Toxin has been administered
  • Pregnant or breastfeeding

BOTOX BLACK BOX WARNING

Postmarketing reports indicate that the effects of Botox and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia (lack or loss of strength and energy), generalized muscle weakness, diplopia (double vision), ptosis (droopy eyelids), dysphagia (difficulty swallowing), dysphonia (problems with voice quality), dysarthria (problems speaking), urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening, and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity, but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have underlying conditions that would predispose them to these symptoms. In unapproved uses, including spasticity in children, and in approved indications, cases of spread of effect have been reported at doses comparable to those used to treat cervical dystonia and at lower doses.

Questions?

If you have any additional questions or concerns regarding the use of Botox in cerebral palsy patients, please contact the physician’s nurse at 858-576-1700, ext. 226014.